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Martín F, Janssen S, Rodrigues V, Sousa J, Santiago JL, Rivas E, Stocker J, Jackson R, Russo F, Villani MG, Tinarelli G, Barbero D, José RS, Pérez-Camanyo JL, Santos GS, Bartzis J, Sakellaris I, Horváth Z, Környei L, Liszkai B, Kovács Á, Jurado X, Reiminger N, Thunis P, Cuvelier C. Using dispersion models at microscale to assess long-term air pollution in urban hot spots: A FAIRMODE joint intercomparison exercise for a case study in Antwerp. Sci Total Environ 2024; 925:171761. [PMID: 38494008 DOI: 10.1016/j.scitotenv.2024.171761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
In the framework of the Forum for Air Quality Modelling in Europe (FAIRMODE), a modelling intercomparison exercise for computing NO2 long-term average concentrations in urban districts with a very high spatial resolution was carried out. This exercise was undertaken for a district of Antwerp (Belgium). Air quality data includes data recorded in air quality monitoring stations and 73 passive samplers deployed during one-month period in 2016. The modelling domain was 800 × 800 m2. Nine modelling teams participated in this exercise providing results from fifteen different modelling applications based on different kinds of model approaches (CFD - Computational Fluid Dynamics-, Lagrangian, Gaussian, and Artificial Intelligence). Some approaches consisted of models running the complete one-month period on an hourly basis, but most others used a scenario approach, which relies on simulations of scenarios representative of wind conditions combined with post-processing to retrieve a one-month average of NO2 concentrations. The objective of this study is to evaluate what type of modelling system is better suited to get a good estimate of long-term averages in complex urban districts. This is very important for air quality assessment under the European ambient air quality directives. The time evolution of NO2 hourly concentrations during a day of relative high pollution was rather well estimated by all models. Relative to high resolution spatial distribution of one-month NO2 averaged concentrations, Gaussian models were not able to give detailed information, unless they include building data and street-canyon parameterizations. The models that account for complex urban geometries (i.e. CFD, Lagrangian, and AI models) appear to provide better estimates of the spatial distribution of one-month NO2 averages concentrations in the urban canopy. Approaches based on steady CFD-RANS (Reynolds Averaged Navier Stokes) model simulations of meteorological scenarios seem to provide good results with similar quality to those obtained with an unsteady one-month period CFD-RANS simulations.
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Affiliation(s)
- F Martín
- CIEMAT, Research Center for Energy, Environment and Technology, Avenida Complutense 40, 28040 Madrid, Spain.
| | - S Janssen
- VITO NV, Flemish Institute for Research and Technology, Boeretang 200, 2400 Mol, Belgium
| | - V Rodrigues
- CESAM & Department of Environment and Planning, University of Aveiro, 3810-193 Aveiro, Portugal
| | - J Sousa
- VITO NV, Flemish Institute for Research and Technology, Boeretang 200, 2400 Mol, Belgium
| | - J L Santiago
- CIEMAT, Research Center for Energy, Environment and Technology, Avenida Complutense 40, 28040 Madrid, Spain
| | - E Rivas
- CIEMAT, Research Center for Energy, Environment and Technology, Avenida Complutense 40, 28040 Madrid, Spain
| | - J Stocker
- Cambridge Environmental Research Consultants (CERC), UK
| | - R Jackson
- Cambridge Environmental Research Consultants (CERC), UK
| | - F Russo
- ENEA, Italian National Agency for New Technologies, Energy and Sustainable Economic Development, 40129 Bologna, Italy
| | - M G Villani
- ENEA, Italian National Agency for New Technologies, Energy and Sustainable Economic Development, 40129 Bologna, Italy
| | - G Tinarelli
- ARIANET S.r.l., via Crespi 57, 20159 Milano, Italy
| | - D Barbero
- ARIANET S.r.l., via Crespi 57, 20159 Milano, Italy
| | - R San José
- Computer Science School, Technical University of Madrid (UPM), Campus de Montegancedo, s/n, 28660 Madrid, Spain
| | - J L Pérez-Camanyo
- Computer Science School, Technical University of Madrid (UPM), Campus de Montegancedo, s/n, 28660 Madrid, Spain
| | - G Sousa Santos
- NILU - The Climate and Environmental Research Institute, Norway
| | - J Bartzis
- University of Western Macedonia (UOWM), Dept. of Mechanical Engineering, Sialvera & Bakola Str., 50132 Kozani, Greece
| | - I Sakellaris
- University of Western Macedonia (UOWM), Dept. of Mechanical Engineering, Sialvera & Bakola Str., 50132 Kozani, Greece
| | - Z Horváth
- SZE, Széchenyi István University, Győr, Hungary
| | - L Környei
- SZE, Széchenyi István University, Győr, Hungary
| | - B Liszkai
- SZE, Széchenyi István University, Győr, Hungary
| | - Á Kovács
- SZE, Széchenyi István University, Győr, Hungary
| | | | - N Reiminger
- AIR&D, Strasbourg, France; ICUBE Laboratory, UMR 7357, CNRS/University of Strasbourg, F-67000 Strasbourg, France
| | - P Thunis
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - C Cuvelier
- European Commission, Joint Research Centre (JRC), Ispra, Italy
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Biddle M, Stylianou P, Rekas M, Wright A, Sousa J, Ruddy D, Stefana MI, Kmiecik K, Bandrowski A, Kahn R, Laflamme C, Krockow EM, Virk H. Improving the integrity and reproducibility of research that uses antibodies: a technical, data sharing, behavioral and policy challenge. MAbs 2024; 16:2323706. [PMID: 38444344 PMCID: PMC10936606 DOI: 10.1080/19420862.2024.2323706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Antibodies are one of the most important reagents used in biomedical and fundamental research, used to identify, and quantify proteins, contribute to knowledge of disease mechanisms, and validate drug targets. Yet many antibodies used in research do not recognize their intended target, or recognize additional molecules, compromising the integrity of research findings and leading to waste of resources, lack of reproducibility, failure of research projects, and delays in drug development. Researchers frequently use antibodies without confirming that they perform as intended in their application of interest. Here we argue that the determinants of end-user antibody choice and use are critical, and under-addressed, behavioral drivers of this problem. This interacts with the batch-to-batch variability of these biological reagents, and the paucity of available characterization data for most antibodies, making it more difficult for researchers to choose high quality reagents and perform necessary validation experiments. The open-science company YCharOS works with major antibody manufacturers and knockout cell line producers to characterize antibodies, identifying high-performing renewable antibodies for many targets in neuroscience. This shows the progress that can be made by stakeholders working together. However, their work so far applies to only a tiny fraction of available antibodies. Where characterization data exists, end-users need help to find and use it appropriately. While progress has been made in the context of technical solutions and antibody characterization, we argue that initiatives to make best practice behaviors by researchers more feasible, easy, and rewarding are needed. Global cooperation and coordination between multiple partners and stakeholders will be crucial to address the technical, policy, behavioral, and open data sharing challenges. We offer potential solutions by describing our Only Good Antibodies initiative, a community of researchers and partner organizations working toward the necessary change. We conclude with an open invitation for stakeholders, including researchers, to join our cause.
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Affiliation(s)
- M. Biddle
- NIHR Respiratory BRC, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - P. Stylianou
- NIHR Respiratory BRC, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - M. Rekas
- NIHR Respiratory BRC, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - A. Wright
- NIHR Respiratory BRC, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - J. Sousa
- NIHR Respiratory BRC, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - D. Ruddy
- NIHR Respiratory BRC, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - M. I. Stefana
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - K. Kmiecik
- NIHR Respiratory BRC, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - A. Bandrowski
- Department of Neuroscience, UC San Diego, La Jolla, CA, USA
| | - R.A. Kahn
- Department of Biochemistry, Emory University School of Medicine, Atlanta, USA
| | - C. Laflamme
- Department of Neurology and Neurosurgery, Structural Genomics Consortium, The Montreal Neurological Institute, McGill University, Canada
| | - E. M. Krockow
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| | - H.S. Virk
- NIHR Respiratory BRC, Department of Respiratory Sciences, University of Leicester, Leicester, UK
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Carreiro-Martins P, Paixão P, Caires I, Rodrigues A, Matias P, Gamboa H, Carreiro A, Soares F, Gomez P, Sousa J, Neuparth N. Diagnosis of COVID-19 by sound-based analysis of vocal recordings. Pulmonology 2023; 29:455-456. [PMID: 37030999 PMCID: PMC10028339 DOI: 10.1016/j.pulmoe.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Affiliation(s)
- P Carreiro-Martins
- Comprehensive Health Research Center, NOVA Medical School, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua Jacinta Marto, 1169-045 Lisboa, Portugal.
| | - P Paixão
- Comprehensive Health Research Center, NOVA Medical School, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - I Caires
- Comprehensive Health Research Center, NOVA Medical School, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - A Rodrigues
- Comprehensive Health Research Center, NOVA Medical School, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - P Matias
- Fraunhofer Portugal AICOS - Porto, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal
| | - H Gamboa
- Fraunhofer Portugal AICOS - Porto, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal; Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics, Faculdade de Ciências e Tecnologia of NOVA, University of Lisbon, Portugal
| | - A Carreiro
- Fraunhofer Portugal AICOS - Porto, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal
| | - F Soares
- Fraunhofer Portugal AICOS - Porto, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal
| | - P Gomez
- NeuSpeLab, CTB, Universidad Politécnica de Madrid, Campus de Montegancedo, s/n, 28223 Madrid, Spain
| | - J Sousa
- NOS Inovação, Rua Actor António Silva, 9 - 6º Piso, Campo Grande, 1600-404 Lisboa, Portugal
| | - N Neuparth
- Comprehensive Health Research Center, NOVA Medical School, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, EPE, Rua Jacinta Marto, 1169-045 Lisboa, Portugal
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Graça CAL, Zema R, Orge CA, Restivo J, Sousa J, Pereira MFR, Soares OSGP. Temperature and nitrogen-induced modification of activated carbons for efficient catalytic ozonation of salicylic acid as a model emerging pollutant. J Environ Manage 2023; 344:118639. [PMID: 37480639 DOI: 10.1016/j.jenvman.2023.118639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/30/2023] [Accepted: 07/15/2023] [Indexed: 07/24/2023]
Abstract
The occurrence of emerging pollutants on effluents of wastewater treatment plants makes unfeasible their reutilization and consequently to comply with the sixth goal of 2030 Agenda for sustainable development. Thus, it is extremely important to find ways to remove these pollutants without compromising the quality of reclaimed water. Ozonation has been successfully explored for this purpose, but it still presents limitations towards some oxidant-resistant pollutants. To surpass this, the conversion of ozone (O3) into more reactive species is required, which can be accomplished by using catalysts. Carbon catalysts, such as activated carbons (ACs), represent a more environmentally attractive option than traditional metal-based catalysts, with the advantage of being easily modified to tune their textural and surface properties to the reaction chemistry. In this study, two different sources of ACs were tested in the catalytic ozonation of a frequently detected emerging pollutant: salicylic acid (SalAc). These ACs were submitted to thermal treatment under H2 and functionalization with N precursors, such as melamine and poly(ethyleneimine), to induce changes in the surface properties, especially in the nitrogen content. Although no correlation was found between the N-content and catalytic activity, the thermal treatment under H2 increased the mesopores surface area (Smeso), which reflected in greater catalytic activity. As that, the best-performing AC was the one with the highest Smeso, which revealed also to be resistant to O3 and able to convert O3 into more reactive species, evidenced by the capacity of oxalic acid, a well-known ozone-resistant by-product. The same AC was then submitted to three consecutive reutilization cycles and a more significant activity loss was observed in terms of SalAc degradation rate (⁓ 40%) then total organic carbon removal (⁓ 25%), from the first to the third cycle. This decline in efficiency was ascribed to the presence of by-products adhered to the catalyst surface, which impede its ability to react effectively with O3.
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Affiliation(s)
- C A L Graça
- LSRE-LCM - Laboratory of Separation and Reaction Engineering - Laboratory of Catalysis and Materials, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal.
| | - R Zema
- INL, International Iberian Nanotechnology Laboratory, Avenida Mestre José Veiga s/n, 4715-330, Braga, Portugal
| | - C A Orge
- LSRE-LCM - Laboratory of Separation and Reaction Engineering - Laboratory of Catalysis and Materials, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - J Restivo
- LSRE-LCM - Laboratory of Separation and Reaction Engineering - Laboratory of Catalysis and Materials, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - J Sousa
- INL, International Iberian Nanotechnology Laboratory, Avenida Mestre José Veiga s/n, 4715-330, Braga, Portugal
| | - M F R Pereira
- LSRE-LCM - Laboratory of Separation and Reaction Engineering - Laboratory of Catalysis and Materials, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - O S G P Soares
- LSRE-LCM - Laboratory of Separation and Reaction Engineering - Laboratory of Catalysis and Materials, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
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Sousa J, Callejas B, Deshpande R, Yousuf M, Taylor L, Wang A, McKay D, Raman M. A196 CROHN’S DISEASE PATIENT DERIVED MACROPHAGES ARE MORE SUSCEPTIBLE TO HYDROGEN PEROXIDE INDUCED CELL DEATH. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991216 DOI: 10.1093/jcag/gwac036.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Crohn’s disease (CD) is characterized by intestinal inflammation due to the interplay between immunity, genetics, and environmental factors such as diet. Selenium (Se) deficiency is common in patients with CD due to malabsorption or high enteric losses. Selenium is used in the synthesis of selenoproteins that have antioxidant properties (e.g. glutathione peroxidases (GPx)) and are highly expressed in macrophages. However, how Se deficiency affects immune system function in patients with CD is unknown. We hypothesize that characterizing Se status, selenoprotein expression and subsequently macrophage function will advance knowledge of mucosal immunity and provide novel insight into CD. Purpose To determine if patients with active CD and healthy controls differ in Se dietary intake and status, oxidative stress, and macrophage cytotoxicity in response to oxidative stress. Method Blood was collected from healthy volunteers and patients diagnosed with ileal, ileocolonic or colonic CD (age ≥18 years, with mild or moderate endoscopic disease activity or fecal calprotectin ≥250 µg/g, and Harvey Bradshaw index <16, stable medications including biologics for at least 8-weeks prior to recruitment). Serum was analyzed for GPx activity, malondialdehyde (MDA) and C-reactive protein (CRP) concentrations. Monocytes were isolated by plastic adherence and treated with M-CSF (10 ng/ml, 7d) to derive macrophages. mRNA expression of GPx1, GPx4 and SelenoP was determined by qPCR. Lactate dehydrogenase release was measured in macrophages treated with 500 µM H2O2 for 2h. Result(s) Samples and/or dietary intake data were collected from 9 patients with CD (3 female, 6 male, mean age=36.8 years) and 13 controls (7 female, 6 male, mean age=27.7 years). Dietary Se intake did not differ between patients with CD and controls (126.1 ± 23.2 vs. 123.3 ± 19.8 µg/day). GPx activity was greater in the serum of patients with CD compared to controls (369 ± 49 vs. 169 ± 27 mU/mL, n=6-8, p<0.005). Patients with CD and controls did not differ in serum MDA concentration (7.80 ± 0.57 vs. 6.53 ± 1.1 µM). CRP levels correlated with serum MDA concentration in patients with CD (r=0.95, n=5, p<0.05) but not GPx activity. Macrophages from patients with CD (n=6) and controls (n=7) did not differ in expression of GPx1 and GPx4 mRNA, whereas SelenoP mRNA was ~200-fold lower in macrophages from patients with CD. Macrophages derived from patients with CD were more susceptible to H2O2-evoked cell death (10.3 ± 1.1 vs. 4.7 ± 0.7 % n=2-3 p<0.05). Conclusion(s) Despite adequate dietary Se intake our findings suggest altered Se metabolism in patients with active CD, with increases in serum GPx potentially indicative of the need for antioxidant activity to counter oxidative stress. The increased sensitivity of macrophages from patients with CD to H2O2 emphasizes the role of oxidative stress and redox balance in IBD. Defining how micronutrients, in this instance Se, impacts innate immunity may provide new approaches to the management of CD. Disclosure of Interest None Declared
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Affiliation(s)
- J Sousa
- Department of Physiology & Pharmacology
| | | | | | - M Yousuf
- Department of Medicine, University of Calgary
| | - L Taylor
- Department of Medicine, University of Calgary
| | - A Wang
- Department of Physiology & Pharmacology
| | - D McKay
- Department of Physiology & Pharmacology,Snyder Institute for Crohnic Diseases
| | - M Raman
- Snyder Institute for Crohnic Diseases,Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Roseiro M, Henriques J, Paredes S, Rocha T, Sousa J. An interpretable machine learning approach to estimate the influence of inflammation biomarkers on cardiovascular risk assessment. Comput Methods Programs Biomed 2023; 230:107347. [PMID: 36645940 DOI: 10.1016/j.cmpb.2023.107347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/28/2022] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Cardiovascular disease has a huge impact on health care services, originating unsustainable costs at clinical, social, and economic levels. In this context, patients' risk stratification tools are central to support clinical decisions contributing to the implementation of effective preventive health care. Although useful, these tools present some limitations, in particular, some lack of performance as well as the impossibility to consider new risk factors potentially important in the prognosis of severe cardiac events. Moreover, the actual use of these tools in the daily practice requires the physicians' trust. The main goal of this work addresses these two issues: (i) evaluate the importance of inflammation biomarkers when combined with a risk assessment tool; (ii) incorporation of personalization and interpretability as key elements of that assessment. METHODS Firstly, machine learning based models were created to assess the potential of the inflammation biomarkers applied in secondary prevention, namely in the prediction of the six month risk of death/myocardial infarction. Then, an approach based on three main phases was created: (i) set of interpretable rules supported by clinical evidence; (ii) selection based on a machine learning classifier able to identify for a given patient the most suitable subset of rules; (iii) an ensemble scheme combining the previous subset of rules in the estimation of the patient cardiovascular risk. All the results were statistically validated (t-test, Wilcoxon-signed rank test) according to a previous verification of data normality (Shapiro-Wilk). RESULTS The proposed methodology was applied to a real acute coronary syndrome patients dataset (N = 1544) from the Cardiology Unit of Coimbra Hospital and Universitary centre. The first assessment was based on the GRACE tool and a Random Forest classifier, the incorporation of inflammation biomarkers achieved SE=0.83; SP=0.84 whereas the original GRACE risk factors reached SE=0.75; SP=0.85. In the second phase, the proposed approach with inflammation biomarkers achieved SE=0.763 and SP=0.778. CONCLUSIONS This approach confirms the potential of combining inflammation markers with the GRACE score, increasing SE and SP, when compared with the original GRACE. Additionally, it assures interpretability and personalization, which are critical issues to allow its application in the daily clinical practice.
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Affiliation(s)
- M Roseiro
- CISUC, Center for Informatics and Systems of University of Coimbra, Coimbra 3030-290, Portugal
| | - J Henriques
- CISUC, Center for Informatics and Systems of University of Coimbra, Coimbra 3030-290, Portugal
| | - S Paredes
- Polytechnic Institute of Coimbra, Coimbra Institute of Engineering (IPC/ISEC), Rua Pedro Nunes, Coimbra 3030-199, Portugal; CISUC, Center for Informatics and Systems of University of Coimbra, Coimbra 3030-290, Portugal.
| | - T Rocha
- Polytechnic Institute of Coimbra, Coimbra Institute of Engineering (IPC/ISEC), Rua Pedro Nunes, Coimbra 3030-199, Portugal; CISUC, Center for Informatics and Systems of University of Coimbra, Coimbra 3030-290, Portugal
| | - J Sousa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, Coimbra 3004-561, Portugal
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Sousa J, Gamas LA, Salazar L, Pinto I, Lunet N. PFO closure for the prevention of cerebrovascular events in high-risk individuals: an updated and across-the-board meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Patent foramen ovale (PFO) closure has emerged as a secondary prevention option in patients with PFO and cerebrovascular events. Despite its seemingly established efficacy, its associated long-term outcomes – including safety – remain unclear.
Purpose
To ascertain the extent to which PFO percutaneous closure is able to improve long-term clinical outcomes in patients with cryptogenic vascular events.
Methods
We systematically searched MEDLINE, Embase and Cochrane CENTRAL for randomized controlled trials (RCTs) and observational studies comparing PFO percutaneous closure with antithrombotic therapy, in what concerns recurrent cerebrovascular and serious adverse events, as well as mortality. A composite of stroke and transient ischemic attack (TIA) was the primary endpoint. Data related to RCTs, patients with high-risk PFO features, subjected to PFO closure with the most represented device and with antiplatelet therapy as control were further investigated separately. Study-specific odds ratios (ORs) were pooled using traditional meta-analytic techniques, under a random- (DerSimonian-Laird method) or a fixed-effects (Mantel-Haenszel method) model.
Results
Literature search yielded 2145 references, of which 26 – 8 regarding RCTs – were included. Patients undergoing PFO closure reached 4304, whereas 4180 were treated with antithrombotic therapy. PFO closure was significantly associated with lower stroke/TIA recurrence (OR 0.35 [0.24–0.53], I2=58%). Moreover, such reduction met statistical significance for both stroke (OR 0.34 [0.21–0.54], I2=29%) and TIA (OR 0.53 [0.34–0.82], I2=39%), individually. Subgroup analyses focusing only on RCTs and on studies featuring the most represented device confirmed these trends, while the effects were even more pronounced in patients with high-risk PFO characteristics and in those controlled with antiplatelet therapy. On the other hand, PFO closure was not associated with neither lower all-cause (OR 0.76 [0.46–1.27], I2=0%) nor lower cardiovascular mortality (OR 0.92 [0.37–2.29], I2=0%). Moreover, neither a composite of serious adverse events (SAEs) (OR 1.10 [0.94–1.29], I2=0%) nor major bleeding episodes (OR 0.75 [0.40–1.38], I2=23%) differed significantly between groups. However, PFO closure was associated with increased odds of procedure- or device-related complications (OR 12.94 [5.56–30.13], I2=0%) and atrial fibrillation or flutter (OR 3.35 [1.78–6.30], I2=30%).
Conclusion
In patients with history of cryptogenic vascular events, when compared with medical management, PFO percutaneous closure is indeed associated with a reduction in the odds of recurrent stroke and TIA. However, mortality seems not to be impacted by this apparently enhanced effect. While general SAEs and major bleeding are comparable between both approaches, PFO closure may bring upon procedure- or device-related complications and increase the odds of atrial fibrillation or flutter.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Sousa
- Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
| | - L A Gamas
- Centro Hospitalar Universitario Sao Joao , Porto , Portugal
| | - L Salazar
- Centro Hospitalar e Universitário do Porto , Porto , Portugal
| | - I Pinto
- Centro Hospitalar Universitario Sao Joao , Porto , Portugal
| | - N Lunet
- Faculdade de Medicina da Universidade do Porto , Porto , Portugal
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Lopes Da Cunha GJ, Rocha B, Sousa J, Maltes S, Brizido C, Strong C, Guerreiro S, Abecasis J, Andrade MJ, Aguiar C, Saraiva C, Freitas P, Mendes M, Ferreira A. Looking beyond left ventricular ejection fraction – a new multiparametric CMR score to refine the prognostic assessment of HF patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac magnetic resonance (CMR) is recommended in Heart Failure (HF) to assess myocardial structure and function. Recently, the quantification of pulmonary congestion and skeletal muscle mass using CMR have been shown to predict adverse events in HF, but a tool integrating this information is currently unavailable. The purpose of this study was to develop and test a new multiparametric CMR-derived score.
Methods
We conducted a single-center retrospective study of consecutive HF patients with left ventricular ejection fraction (LVEF) <50% who underwent CMR. Several CMR parameters with known prognostic value were assessed, including: LVEF, Lung Water Density (LWD), Pectoralis Major Muscle (PMM) area, and presence of Late Gadolinium Enhancement. PMM area was outlined at the level of the carina – Figure 1A, B – and LWD was defined as the lung-to-liver signal ratio multiplied by 0.7, as previously described. Both parameters were measured in standard HASTE images - Figure 1C. The primary endpoint was a composite of all-cause death or HF hospitalization. Using the Cox regression Hazard Ratios of designated variables, a risk score was developed.
Results
Overall, 436 patients were included. During a median follow-up of 27 (17–37) months, 43 (9.9%) patients died and 57 (13.2%) had at least one hospitalization for HF. LVEF, LWD and PMM were independent predictors of the primary endpoint and were included in the CMR-HF score – Figure 2. The annual rate of events increased from 4.7 to 7.5 and 20.0% from lowest to highest tertile of the score. Roughly half of the events (54%) occurred in patients in the highest tertile of the CMR-HF score. In multivariate analysis, the new score independently predicted the primary endpoint (HR per 5 points: 1.54; 95% CI: 1.21–1.97; p<0.001) even after adjustment for age, body mass index, NYHA class, NT-proBNP, estimated glomerular filtration rate, presence of implantable cardioverter-defibrillator, and ischemic etiology.
Conclusions
This novel multidimensional CMR-HF score, combining easily obtainable data on left ventricular pump failure, lung congestion and muscular wasting, is a promising tool identifying HF patients with an LVEF <50% at higher risk of death or HF hospitalization.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - B Rocha
- Hospital Santa Cruz , Lisbon , Portugal
| | - J Sousa
- Hospital Santa Cruz , Lisbon , Portugal
| | - S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | - C Brizido
- Hospital Santa Cruz , Lisbon , Portugal
| | - C Strong
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | | | - C Aguiar
- Hospital Santa Cruz , Lisbon , Portugal
| | - C Saraiva
- Hospital Santa Cruz , Lisbon , Portugal
| | - P Freitas
- Hospital Santa Cruz , Lisbon , Portugal
| | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
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9
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Carvalho JG, Sousa J, Fernandes C, França M. Chest calcifications beyond the lung parenchyma-A review. Radiologia (Engl Ed) 2022; 64:456-463. [PMID: 36243445 DOI: 10.1016/j.rxeng.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/12/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Thoracic calcifications are frequently found in chest radiographs and CTs, occurring in a wide variety of disorders. Although most calcifications are harmless sequelae of previous disease, they provide important information to establish the diagnosis. This article reviews the different types of calcified lesions found in the chest, focusing on lesions outside the lung parenchyma. A location-based approach to the differential diagnosis is used, while providing the reader with diagnostic pearls and discussing the clinical importance of the different types of calcifications. CONCLUSION Chest calcifications are a common finding in routine chest imaging. Understanding the different etiologies and radiologic manifestations provide the radiologist with the necessary tools to elaborate a differential diagnosis, as well as to correctly differentiate the findings that need further work-up from the ones that can be dismissed.
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Affiliation(s)
- J G Carvalho
- Departamento de Radiología, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - J Sousa
- Departamento de Radiología, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - C Fernandes
- Departamento de Radiología, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - M França
- Departamento de Radiología, Centro Hospitalar Universitário do Porto, Porto, Portugal
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10
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Brito J, Silverio Antonio P, Silva P, Couto Pereira S, Valente Silva B, Cunha N, Nunes-Ferreira A, Lima Da Silva G, Neves I, Cortez-Dias N, J Pinto F, Sousa J. SAECG - advances in Brugada stratification. Europace 2022. [DOI: 10.1093/europace/euac053.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Brugada syndrome (BrS) is a relevant cause of sudden cardiac death (SCD) in young adults. Several risk factors have been identified, but clinical decision making remains extremely challenging, particularly in asymptomatic patients.
Purpose
To explore the usefulness of the non-invasive assessment of late potentials (LPs) based signal-averaged ECG (SAECG) for risk stratification in BrS.
Methods
Prospective single-center study of patients with BrS included from 2003 to 2021. LPs were evaluated by SA-ECG with determination of the total filtered QRS duration (fQRS), root mean square voltage of the 40ms terminal portion of the QRS (RMS40) and duration of the low amplitude electric potential component of the terminal portion of the QRS (LAS40) in conventional and modified right precordial leads.
The primary endpoint was the occurrence of malignant arrhythmic events (MAEs), defined as a composite of SCD or appropriate shocks. Uni- and multivariate Cox regression survival analyses were used to identify significant prognostic predictors considering the clinical, genetic, and electrocardiographic characteristics as well as the tercile distribution of the SAECG parameters. A risk score was computed incorporating the significant LPs variables and its usefulness for prognostic stratification was explored using Kaplan Meier survival analysis.
Results
Our cohort consisted of 117 patients (mean age: 47±13 years, 33% male), including 75 (65%) with type 1 spontaneous pattern and 92 (79%) asymptomatic individuals. Symptoms at presentation included syncope in 16 pts (14%) and polymorphic VT/cardiac arrest in 4 (3.4%).
During a median follow-up of 4.1±0.3 years, 8 pts (6.8%) suffered MAEs: 3 (2.6%) with SCD and 5 (4.3%) with appropriate shocks.
The risk of events differed in relation to the several SAECG parameters (Table 1), increasing linearly with the fQRS duration determined either in the conventional (HR 1.03, 95% CI 1.01-1.06, p=0.008) or modified leads (HR: 1.03, 95% CI 1.01- 1.05, p=0.003). The SAECG score incorporated as risk markers a fQRS ≥113ms and a RMS40 <13 μV. Patients with both risk markers presented a 7-fold increased risk (HR 7.17, 95% CI 1.29-40, p = 0.025), independently of the baseline symptomatic status and ECG pattern.
Conclusion
This study shows that the non-invasive assessment of LPs based on SAECG is useful for prognostic stratification of BrS. It was possible to identify a subset of patients presenting a high risk of events who may deserve individualized preventive strategies.
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Affiliation(s)
- J Brito
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Silverio Antonio
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - S Couto Pereira
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - B Valente Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Cunha
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - A Nunes-Ferreira
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - G Lima Da Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - I Neves
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Cortez-Dias
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - F J Pinto
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - J Sousa
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
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11
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Oliveira C, Silverio Antonio P, Couto Pereira S, Valente Silva B, Brito J, Alves Da Silva P, Martins AM, Garcia B, Azaredo Raposo M, Nunes Ferreira A, Lima Da Silva G, Carpinteiro L, Cortez-Dias N, J Pinto F, Sousa J. Non-ischemic cardiomyopathy: what predicts survival and ICD shocks after ventricular tachycardia ablation? Europace 2022. [DOI: 10.1093/europace/euac053.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Patients (pts) with non-ischemic cardiomyopathy (NICM) present an increased morbidity and mortality from sustained monomorphic ventricular tachycardia (VT). Implantable cardiac defibrillators effectively terminate VT, but ablation is usually required to prevent recurrences and appropriate shocks. Although several risk factors have been pointed out, clear prognostic predictors need to be established and addressed.
Purpose
To evaluate risk factors associated with all-cause mortality and ICD shocks in NICM pts submitted to VT ablation.
Methods
Prospective, observational, single-centre study of pts with NICM submitted to VT ablation using high density mapping tools.The primary outcome was all-cause death or VT recurrence terminated with appropriate ICD shock during long-term follow up. Kaplan-Meier analysis was used to estimate the long-term event-free survival. Uni and multivariate Cox regression analyses were used to determine relevant prognostic predictors.
Results
A total of 27 consecutive pts with NICM were referred for a first-ever VT ablation procedure between June 2015 and June 2021 (males: 93%; mean age: 61±12 years). The mean left ventricular ejection fraction (LVEF) was 35±12% and 70% of pts had NYHA class I or II.
During a mean follow-up of 29 ± 19 months, VT recurrences requiring ICD shocks occurred in 25.9% of pts. VT ablation success and the risk of ICD shocks were not associated with any of the clinical characteristics. Long-term all-cause mortality was 37%. In univariate analysis, LVEF <30%, NT-proBNP, NYHA classification III-IV, chronic kidney disease (CKD), ICD for secondary prevention and prior VT ablation (p=0.08) were associated with reduced survival. On multivariate analysis, CKD was identified as the strongest independent survival predictor (HR 6.9; CI95%: 1.5-23-2, p=0.010)
Conclusions
In pts with NIDM, VT ablation may be successful even in pts with advanced heart disease. However, long-term survival will depend mostly on the stage of disease progression and is strongly associated with the clinical markers of end-stage heart failure. Therefore, a timely referral is crucial to derive the best clinical benefit from VT ablation in this population.
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Affiliation(s)
- C Oliveira
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Silverio Antonio
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - B Valente Silva
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - AM Martins
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - B Garcia
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - M Azaredo Raposo
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - A Nunes Ferreira
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - G Lima Da Silva
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - L Carpinteiro
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Cortez-Dias
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - F J Pinto
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - J Sousa
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
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12
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Garcia A, Brito J, Couto Pereira S, Silverio Antonio P, Silva B, Alves Da Silva P, Simoes De Oliveira C, Martins A, Nunes Ferreira A, Silva G, Carpinteiro L, Cortez Dias N, J Pinto F, Sousa J. Epicardial mapping as first intention approach for structural ventricular tachycardia ablation. Europace 2022. [DOI: 10.1093/europace/euac053.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
In several structural arrhythmogenic diseases that comprise intricate endocardial, intramural and epicardial substrates, endocardial ablation of ventricular tachycardia (VT) is not sufficient and epicardial ablation has lately become a complementary and necessary tool.
Purpose
To evaluate the clinical characteristics of patients (pts) most suitable for first intention epicardial VT ablation.
Methods
Single-center prospective study of consecutive pts with structural heart disease undergoing first intention epicardial VT mapping between August 2015 and June 2021. Decision for epicardial approach was based on the etiology, VT electrocardiogram (ECG) and cardiac magnetic resonance (CMR) results. Under general anesthesia, subxiphoid access using a Tuhoy needle was done using fluoroscopic guidance and with high-density epicardial mapping was performed. Epicardial ablation was performed if relevant arrhythmogenic findings were locally confirmed.
Results
First intention epicardial VT ablation was attempted in 18 pts (mean age 59.8±12 years,94% male) of whom 16 had non-ischemic dilated cardiomyopathy (NICM,idiopathic:11; post-myocardis:4; hereditary:1) and 2 had right ventricular arrhythmogenic cardiomyopathy. Mean LVEF was 33% and 79% had a previous ICD (53% in primary prevenon). 69% were referred for ablation due to arrhythmic storm (1pt in cardiogenic shock). Epicardial access was achieved in 17 pts (94%), without acute complications. In 35% pts with NICM the decision for epicardial approach was based on the detection of subepicardial CMR delayed-hyperenhancement and relevant epicardial arrhythmic substrate was confirmed by mapping in all cases. In 3 pts radiofrequency (RF) applicaons were not performed at epicardium, as no abnormal electrograms were locally detected, and an addional endocardial approach was prosecuted. The mean overall procedure and fluoroscopic time were 123 and 28min, respectively, with a mean RF application me of 51min. After the procedure 1pt required pericardial drainage due to inflammatory pericardial effusion. No other acute complications occurred. During a mean follow-up of 2.8±1.8 years, only 3pts (17%) had VT recurrence; 5pts (28%) died due to end-stage heart failure and 2pts (11%) underwent heart transplantation.
Conclusion
In NICM a first intention epicardial VT ablation performed by experienced operators/centers is efficient, particularly if guided by CMR findings,and presents a safety profile.
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Affiliation(s)
- A Garcia
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - J Brito
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - S Couto Pereira
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - P Silverio Antonio
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - B Silva
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - P Alves Da Silva
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | | | - A Martins
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - A Nunes Ferreira
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - G Silva
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - L Carpinteiro
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - N Cortez Dias
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - F J Pinto
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
| | - J Sousa
- CHULN and Faculty of medicine of the University of Lisbon, Lisbon, Portugal
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13
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Silva BV, Silverio Antonio P, Couto Pereira S, Alves Da Silva P, Brito J, Garcia B, Oliveira C, Martins AM, Nunes Ferreira A, Magalhaes A, Cristina H, J Pinto F, Sousa J, Marques P. Upgrade pacemaker to CRT: predictors and the importance of LVEF. Europace 2022. [DOI: 10.1093/europace/euac053.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Nowadays 10-15% of CRT implantaon is upgrading from paents (pts) with pacemaker (PMK) who develop reduced LVEF and worsening symptoms from HF. There are few retrospecve studies showing some predictors of pts with single or dual chamber PMK that may need upgrade to CRT, but it is not completely established which pts may benefit the most.
Purpose
To identify predictors at follow-up of upgrading pacemaker to CRT in a population with pacemaker implantation.
Methods
Single center case-control study of pts that performed upgrading to CRT-pacemaker (CRT-P) in our hospital. We excluded pts that performed upgrade to CRT-D. We compare to a PMK populaon matched to age at implantaon and cause of PMK implantaon. Demographic, clinic and electrocardiographic (ECG) data were considered at baseline. Echocardiographic evaluation was performed before pacemaker/CRT upgrading implantaon and at follow-up. Predictors of upgrading were evaluated by the Cox regression. Prognosc impact of LVEF was evaluated as upgrading to CRT-P by Kaplan-Meier curves.
Results
We included 71 pts that performed CRT-P upgrade (mean age 77±10; 49,6% male, mean LVEF before PMK 54.9±9.2%) and 71 pts with pacemaker implantaon (mean age 78 ± 11; 50,4% male; mean LVEF 60.9±7.2%). The clinical characteriscs, ECG and echocardiographic were similar between pacemaker and CRT-P-upgrade, except atrial fibrillaon being more prevalent in PMK group (57.5% vs 42.5% p=0.039). Mortality was not different duringfollow-up between the two groups. In univariate analysis, QRS duraon (PMK: 115ms vs upgrade CRT-P: 132 ms, p=0.038), LVEF (PMK: 60.9% vs upgrade CRT-P: 54.9%, p=0.002) and LV end-diastolic diameter (LVEDD) (PMK: 48.9.4 ± 6.6mm vs upgrade CRT-P: 56.4 ± 6.6mm, p=0.001), LV end-sistolic diameter (LVESD) (PMK: 29.5 ± 6.5mm vs upgrade CRT-P: 37.9 ± 9 mm, p=0.006) were associate to upgrading to CRT. In our population, the unique independent predictor was lower LVEF(Long Rank 6.108, p=0.013) – Figure 1. The best LVEF cut- off to predict upgradingto CRT was 55% (AUC 0.954, sensitivity 64%, specificity 84%) – Figure 2.
Conclusion
In our populaon of CRT upgrading pts, a broad QRS duraon, lower LVEF and a higher LVEDD and LVESD were associated to upgrade to CTR-P. We try to establish a new value for LVEF that could lead to upgradingto CRT-P, and maybe the classical cut-off of 50% should be reviewed.
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Affiliation(s)
- BV Silva
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silverio Antonio
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - B Garcia
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - C Oliveira
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - AM Martins
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Nunes Ferreira
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Magalhaes
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - H Cristina
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - F J Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Sousa
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Marques
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
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14
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes A, Saleiro C, Campos D, Sousa J, Lopes J, Puga L, Teixeira R, Lourenco C, Madeira M, Goncalves L. Inflammation in acute coronary syndrome: prognostic significance. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In patients with acute coronary syndrome (ACS) the acute phase reactant, C-reactive protein (CRP), might be significantly elevated. Several reports suggest that CRP may play a direct pathophysiological role on the development and progression of atherosclerosis, and CRP values correlate with infarct size when measured by magnetic resonance imaging.
Purpose
The aim of the present study was to evaluate the prognostic value of CRP in patients presenting with an ACS.
Methods
Retrospective analysis of 635 consecutively admitted patients due to ACS in a single coronary intensive care unit. CRP levels were measured at admission. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether CRP was an independent predictor of outcome.
Results
In the studied sample, 75% were male. Median age was 69 [interquartile range (IQR) 57–78]. ST-elevation myocardial infarction (STEMI) occurred in 39.6%, non-ST segment elevation myocardial infarction in 44.9% and unstable angina in 15.5% of the patients. Median left ventricular ejection fraction (LVEF) was 48% (IQR 40–55%) and median CRP level at admission 0.7 mg/dL (IQR 0.5–1.9 mg/dL). Regarding important comorbidities and past medical history, 75.9% had hypertension (HTN), 34.0% diabetes, 20.3% chronic kidney disease (CKD), 68.6% dyslipidaemia and 17.3% heart failure (HF). The median follow-up was 34 months (IQR 22–72). In univariate analysis, CRP was significantly associated with all-cause mortality (HR 1.06 per 1 mg/dL increase, 95% CI 1.04–1.08, p<0.001), as was gender, age, LVEF, STEMI and previous history of diabetes, HTN, CKD or HF. In multivariate analysis, CRP remained significantly associated with the primary endpoint (HR 1.02, 95% CI 1.00–1.05, p=0.033), as did age, LVEF and previous history of HF.
Conclusions
In our study, CRP at admission was an independent risk factor for all-cause mortality following an ACS. This finding indicates that inflammation associated with the acute event has a significant impact in the long-term prognosis. More evidence is needed to determine if treating inflammation (and when, in the course of the disease) could result in better outcomes.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto, Porto, Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - A Gomes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - D Campos
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - L Puga
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - R Teixeira
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
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15
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Carvalho R, Rodrigues T, Rocha R, Ribeiro J, Silva G, Carpinteiro L, Cortez-Dias N, Sousa J. Real-world comparison of different periprocedural antithrombotic strategies for atrial fibrillation catheter ablation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Atrial Fibrillation (AF) catheter ablation carries high bleeding and thromboembolic risks, requiring a detailed assessment of overall risk-benefit profile regarding antithrombotic strategy. Vitamin K Anticoagulant (VKA) and Non-Vitamin K Antagonist Oral Anticoagulant (NOAC) have been used in the latest years in this setting, and with different interruption protocols periprocedural. Our goal was to evaluate the rate of acute adverse events (AAE) and compare them according to antithrombotic strategy used periprocedural, in a real-world basis.
Methods
A single-center retrospective study, including adult patients admitted to first AF catheter ablation, from 2004 to 2020. Different antithrombotic strategies (anticoagulation with VKA uninterrupted, anticoagulation with NOAC uninterrupted, no therapy or antiaggregation/interrupted ACO) were compared concerning the rate of any clinically relevant AAE; the composite of major AAE (hemopericardium and stroke/transient ischemic attack [TIA]) and minor AAE associated with vascular access. Descriptive statistics and logistic regression were used to compare groups according to the antithrombotic strategy with an alpha level of 0.05.
Results
Among the 868 patients included (mean age 59±12 yo, 67,5% [n=586] men), pulmonary vein isolation was performed under uninterrupted anticoagulation in 640 (73,7%), of which 595 patients with NOAC (68,5%) and 45 with VKA (5,2%). AF was paroxysmal, persistent and long-standing persistent in 63,4% (n=550), 21,4% (n=185) and 15,4% (n=133) patients, respectively. Mean CHADS-VASc score was 1,86±1,48. Over time there was a shift in the distribution of the type of antithrombotic therapy used, consistent with changes in recommendations (Graph 1).
The composite outcome occurred in 6,8% (n=62), including hemopericardium in 1,8% (n=16), stroke/TIA in 0,7% (n=6) and events related to vascular access in 1,4% (n=13) [Table 1]. No anticoagulation therapy or antiaggregation/interrupted ACO was more associated to the outcome, driven by major AAE, although the difference did not meet statistical significance (p=0,06) [Table 1]. No difference was found between VKA and NOAC group. Additionally, there was no diference in the incidence of hemorrhagic AAE since the implementation of an uninterrupted anticoagulation strategy periprocedural.
Conclusion
In our population of patients submitted to AF catheter ablation, an uninterrupted anticoagulation strategy is associated with lower rate of AAE, either with VKA or NOAC. Our real-world results are reassuring of the benefit of an uninterrupted strategy, and consistent with recent controlled trials.
Funding Acknowledgement
Type of funding sources: None. Antithrombotic therapies over timeClinically relevant acute adverse events
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Affiliation(s)
- R Carvalho
- Hospital Santo Andre, Cardiology, Leiria, Portugal
| | - T Rodrigues
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
| | - R Rocha
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Ribeiro
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
| | - G.L Silva
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
| | - L Carpinteiro
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
| | - N Cortez-Dias
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
| | - J Sousa
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
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Sousa J, Lourenco R, Lopes J, Saleiro C, De Campos D, Lourenco C, Goncalves L. Bisphosphonates and atrial fibrillation risk: a final word. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Bisphosphonates (BPs) are widely prescribed drugs that decrease bone fracture risk in osteoporosis patients. Nevertheless, the class has been associated with a plethora of adverse effects, including incidental atrial fibrillation (AF). This epidemiologic link has, however, been met with skepticism by some authors.
Purpose
To perform a meta-analysis aimed at ascertaining the extent to which BPs might increase the odds of AF.
Methods
We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar, from inception to the first of March, 2021, for randomized controlled trials comparing oral or intravenous BPs with placebo or a no-treatment control, in what concerns AF risk. In order to be included in the quantitative analysis, studies were required to feature a minimum patient follow-up of 6 months. De novo AF diagnoses served as the primary endpoint. Data related to individual BPs were further investigated separately, with respect to this outcome. Study-specific Mantel-Haenszel odds ratios (ORs) were pooled using traditional meta-analytic techniques, under a random-effects model.
Results
42 RCTs, encompassing 52.436 patients (32.071 randomized to BPs), were regarded as eligible for quantitative synthesis. Of note, 2 pooled analyses, one of 4 trials with ibandronate and the other of 6 trials with risedronate, were included. Individual BP representation may be depicted as follows: Alendronate, 23 trials, with 14.599 patients; Risedronate, 7 trials, with 15.350 patients; Zoledronic acid, 7 trials, with 13.059 patients; Ibandronate, 4 trials, with 8.754 patients; and Minedronate, 1 trial, with 674 patients. 748 de novo AF diagnoses were reported, in total. In the main analysis, BPs were not found to be significantly associated with an increase in AF odds (OR 1.10, 95% CI 0.95–1.28, P 0.21, i2 0%). As for individual BPs, Alendronate (OR 1.09, 95% CI 0.82–1.45, P 0.55, i2 0%), Risedronate (OR 0.81, 95% CI 0.35–1.86, P 0.61, i2 31%), Ibandronate (OR 0.89, 95% CI 0.52–1.52, P 0.67) and Minedronate (0 AF events reported, both in the active and in the control group) were also not shown to meaningfully enhance AF risk. On the contrary, Zoledronic acid utilization was associated with a significant, though small, increase in new AF cases (OR 1.29, 95% CI 1.01–1.64, P 0.04, i2 0%).
Conclusion
The professed BP-driven increase in AF odds is not apparent in a fairly populated randomized setting. In fact, a barely significant increment in AF risk seems only to occur with the most potent BP (Zoledronic acid). Therefore, AF development concerns should not refrain doctors from prescribing this highly effective pharmacological class.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | | | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D De Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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17
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Monteiro E, Pedro Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes A, Saleiro C, Campos D, Sousa J, Lopes J, Puga L, Teixeira R, Lourenco C, Madeira M, Goncalves L. Prognostic significance of percutaneous coronary intervention associated blood loss in acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Antiplatelet and anticoagulants are one of the mainstay treatment of acute coronary syndrome (ACS), however they are associated with a significant increase of bleeding risk. While anaemia is a recognized predictor of adverse outcomes, it is unknown if a variation of haemoglobin (HB) levels, even without associated anaemia, has the same impact.
Purpose
The aim of this study was to determine the prognostic impact of HB variation after percutaneous coronary intervention (PCI) in ACS patients.
Methods
Retrospective analysis of 822 consecutive patients admitted due to ACS and treated with PCI, in a single coronary intensive care unit. Delta HB – ΔHB – (HB at admission – HB 24 hours after PCI) was calculated. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether ΔHB was independent from other known factors in predicting the outcome.
Results
In the studied sample, 75.4% were male. Mean age was 66.4±13.1. ST-elevation myocardial infarction (STEMI) occurred in 45.5%, non-ST segment elevation myocardial infarction in 42.6% and unstable angina in 11 9% of the studied population. Moderate to severe systolic dysfunction was present in 23.5% of the cases. Regarding comorbidities and past medical history, 76% had hypertension (HTN), 30.3% diabetes, 16.4% chronic kidney disease (CKD), 62.2% dyslipidaemia and 10.5% heart failure (HF). Mean HB at admission was 13.8±1.8 g/dL, mean HB after PCI was 12.9±1.9 g/dL and mean ΔHB was 0.9±1.1 g/dL. The mean follow-up was 51.6±30.6 months. In univariate analysis, ΔHB was significantly associated with all-cause mortality (HR 1.15 per 1 g/dL loss, 95% CI 1.01–1.30, p=0.04), as was HB at admission, HB after PCI, age, sex, diabetes, HTN, dyslipidaemia, CKD and moderate to severe systolic dysfunction. In multivariate analysis, ΔHB remained significantly associated with the endpoint and gained even more statistical power (HR 1.25, 95% CI 1.10–1.43, p<0.01). HB at admission and after PCI, age, CKD and moderate to severe systolic dysfunction were also independent predictors of this outcome.
Conclusions
In our study, irrespective of the admission and discharge HB, ΔHB was associated with more adverse outcomes in patients submitted to PCI. Hence, even patients with a normal HB after PCI have a worse long-term prognosis if a negative variation of HB occurs. This highlights the importance of identifying and optimising all the correctable factors that might lead to an increased bleeding risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | | | - J Guimaraes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Fernandes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - G Costa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - A Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - R Teixeira
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - M Madeira
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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18
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Sousa J, Gomes AR, Lopes J, Saleiro C, Lourenco C, Goncalves L. Subsegmental pulmonary embolism: yet another case for being a medical conservative. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The advent of multi-detector computed tomographic pulmonary angiography has allowed better assessment of the peripheral pulmonary arteries, thereby increasing the incidence of pulmonary embolism (PE). Even though most patients with PE are treated with anticoagulation, its value in the subsegmental setting (SSPE) has not yet been confirmed.
Purpose
To perform a meta-analysis aimed at ascertaining the extent to which anticoagulation results in a net positive effect in patients with SSPE.
Methods
We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar, from inception to March 2021, for controlled studies addressing the effect of anticoagulation on SSPE patients. Specifically, venous thromboembolism (VTE) recurrence served as the primary efficacy endpoint, whereas clinically significant bleeding represented the primary safety outcome. Furthermore, major bleeding, PE-related and all-cause mortality were also studied, as secondary endpoints. All anticoagulation strategies, namely oral or parenteral, met inclusion criteria. Study-specific odds ratios (ORs) were pooled, under a random-effects model.
Results
1 cross-sectional, 8 retrospective and 4 prospective non-randomized studies, encompassing 82, 641 and 157 patients, respectively, were regarded as eligible for quantitative evaluation. 667 patients (75.8%) were allocated to the anticoagulation arm. The absolute number of events for each outcome may be reported as follows: primary efficacy endpoint, 5; primary safety endpoint, 60; major bleeding, 38; PE-related mortality, 0; all-cause mortality, 25. 7 studies reported their respective outcomes under a prespecified 3-month follow-up period, while only 1 featured cancer patients as its entire sample. As for the primary efficacy endpoint, and despite the surprising adjudication of all its 5 events to the anticoagulated patients, their relative overrepresentation (371 vs. 143 patients) stemmed a non-significant tendency towards a decrease in VTE recurrence in this arm (OR 0.59, 95% CI 0.09–3.81, P 0.58, i2 0%). On the other hand, anticoagulation was associated with a significant increase in clinically significant hemorrhages (OR 2.89, 95% CI 1.07–7.80, P 0.04, i2 0%) and a non-significant propensity towards an increment in major bleeding (OR 2.44, 95% CI 0.79–7.59, P 0.12, i2 0%). Lastly, and even though no events of PE-related mortality were reported, anticoagulation was linked with a meaningful reduction in all-cause mortality (OR 0.31, 95% CI 0.11–0.82, P 0.02, i2 0%).
Conclusion
Currently available evidence underpins marginal efficacy and safety concerns regarding the use of anticoagulation in SSPE patients, who are expected to experience very low to none PE-related mortality. The association of anticoagulation with lower all-cause death may be attributable to selection bias. Randomized controlled trials are, however, still needed to fully validate this hypothesis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - A R Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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Graca Rodrigues T, Cunha N, Brito J, Silverio-Antonio P, Couto Pereira S, Silva B, Silva P, Barreiros C, Lima Da Silva G, Cortez-Dias N, Carpinteiro L, Pinto F, Sousa J. Is balloon cryoablation effective in common pulmonary trunk? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Common pulmonary trunk (CPT) accounts for the most frequent pulmonary vein anatomical variation. The most frequent technique used for pulmonary vein isolation (PVI) is point-by-point radiofrequency, using cryoablation (CB) is still debatable. Some few studies have shown the feasibility and safety of CB in CPT atrial fibrillation (AF) patients (pts), most of them performed angio-CT prior to ablation.
Purpose
To analyzed AF pts with and without CPT submitted to CB in regarding of success rate and safety.
Methods
Single-center retrospective study of consecutive AF pts refractory to antiarrhythmics submitted to CB between 2017 and 2020. Before the procedure auriculography was performed in all pts to verify variations in pulmonary veins, however the procedure was not modify regarding the presence of CPT. Clinical records were analyzed to determine baseline characteristics, success rate and complications. Monitoring was performed with a 7-day event loop recorder at 3, 6 and 12 months and annually from the 2nd year. Success was defined by recurrence of AF (duration >30 seconds). Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using Chi-square and Mann-Whitney analysis.
Results
A total of 232 pts (60±12 years, 68% males) underwent CB. 29 pts had CPT (28 – common left pulmonary trunk and 2 – common right pulmonary trunk). Baseline characteristics were similar between groups, except for CHA2DS2VASc score and prior cerebrovascular disease history which were higher in CPT pts (3±2 vs 2±2, p=0.001; 24.1% vs 6.8%, p=0.007, respectively). The mean baseline CHA2DS2VASc was 2±2 and the median post-CB follow-up was 135 (IQ 32–249) days.
Both the 1 and 3 year arrhythmic recurrence after AF ablation was not significantly different when comparing CPT and non CPT group with a 3 year success rate of 95.8% in pts with CPV against 86.5% in pts without CPT (p=0.299).
There was no difference between groups (p=0.296; p=0,164, respectively) regarding the time of the procedure, radiation dose and rate of complications.
Conclusions
In our experience, balloon cryoablation for PVI is a safe and successful procedure in patients with CPT anatomical variation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T.E Graca Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silverio-Antonio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - B Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - C Barreiros
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - G Lima Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cortez-Dias
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - L Carpinteiro
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - F.J Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Sousa
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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Sousa J, Lima A, Gil P, Henriques J, Goncalves L. The quest for GRACE 3.0: improving our beloved risk score with machine learning. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although widely recommended for risk assessment of patients with acute coronary syndrome (ACS), the Global Registry of Acute Coronary Events (GRACE) score famously lacks discriminative power. On the other hand, in-hospital serum hemoglobin levels (HG) have been shown to simultaneously forecast both thrombotic and hemorrhagic hazards.
Purpose
To ascertain the extent to which the incorporation of HG in the GRACE score is able to increase its predictive ability.
Methods
Retrospective single-center study encompassing ACS patients consecutively admitted to a Cardiac Intensive Care Unit. Inclusion criteria comprised the acquaintance of GRACE score, HG and vital status on a 6-month follow-up, which served as the outcome. 3 discriminative models were first created: (standard) GRACE score (model 1); GRACE score plus HG, by means of logistic regression (model 2); GRACE score plus HG, by means of multilayer perceptron (a class of feedforward artificial neural network) (model 3). Hereafter, if models 2 and/or 3 were to be found significantly more discriminative than model 1, a correction factor would be calculated, also allowing for the conception of the most predictive model possible (model 4). The discriminative ability was estimated by both the area under the receiver-operating characteristic curve (AUC), and the dyad sensitivity/specificity.
Results
Between April 2009 and December 2016, 1468 patients met study inclusion criteria. Mean age was 68.0±13.2 years and 29.8% were female, while 36.9% presented with ST-segment elevation myocardial infarction. Mean GRACE score was 145.5±47.0 and mean HG was 13.5±2.0. All-cause mortality reached 10.5%, at 6 months. Predictive power for models 1, 2 and 3 may be quantified as follows: AUC 0.6998, sensitivity 77.7% and specificity 62.5%; AUC 0.7818, sensitivity 36.3% and specificity 92.2%; AUC 0.7851, sensitivity 47.7% and specificity 88.5%, respectively. Both models 2 and 3 exhibited more discriminative ability than model 1 (p<0.001), due to their higher specificity. As such, a correction factor was computed (y = −7.8556x + 86.4117) and model 4 was created, displaying a sensitivity of 65.9% and a specificity of 76.5%.
Conclusion
HG single-handedly provides incremental predictive value – namely more specificity – to the GRACE score. In particular, the latter seems to overestimate ACS patients' risk if HG is normal or close to normal.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - A Lima
- University of Coimbra, Informatics Engineering, Coimbra, Portugal
| | - P Gil
- University of Coimbra, Informatics Engineering, Coimbra, Portugal
| | - J Henriques
- University of Coimbra, Informatics Engineering, Coimbra, Portugal
| | - L Goncalves
- University of Coimbra, Informatics Engineering, Coimbra, Portugal
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21
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Cruz N, Batista A, Cardoso J, Carvalho B, Carvalho P, Combo A, Correia M, Fernandes A, Pereira R, Rodrigues A, Santos B, Sousa J, Gonçalves B. Advanced high-performance processing tools for diagnostics and control in fusion devices. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Cruz L, Silva A, Lopes J, Damas D, Lourenço J, Costa A, Silva F, Sousa J, Galego O, Nunes C, Veiga R, Machado C, Rodrigues B, Cecilia C, Almendra L, Bras A, Santo G, Machado E, Sargento-Freitas J. Early Cerebrovascular Ultrasonography as a Predictor of Hemorrhagic Transformation After Thrombectomy. J Stroke Cerebrovasc Dis 2021; 30:105922. [PMID: 34157670 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To determine the predictive value of early transcranial color-coded sonography (TCCS) for intracranial hemorrhage (ICH) in patients with large artery occlusion (LAO) stroke of carotid circulation, who were submitted to endovascular therapy (EVT) with successful reperfusion. MATERIALS AND METHODS Retrospective study evaluating a cohort of consecutive stroke patients with LAO of the carotid circulation that were recanalyzed with EVT. We measured angle-corrected peak systolic velocities, end-diastolic velocities and mean flow velocities (PSV, EDV and MFV) of the symptomatic and asymptomatic middle cerebral artery (MCA). The ratio between MFV of the symptomatic MCA and MFV of the asymptomatic MCA (MCA-Ra) was calculated. Parenchymal hematoma in the 24 hours control CT was considered as ICH. Univariate associations and multivariate analyses were used to identify early independent predictors for ICH among TCCS findings. RESULTS We included 234 patients, mean age 72.5 (SD 12.6) years, 52.1% male. The mean time between recanalization and TCCS was 12.3 hours (range 3-22). Patients who developed postinterventional ICH showed a higher MCA-Ra (1.02 ± 0.26 vs 1.16 ± 0,21, p = 0.036). In multivariate analysis, only higher MCA-Ra remained independently associated with postinterventional ICH (OR: 6.778, 95%CI: 1.152-39.892, p = 0.034). A value of MCA-Ra ≥ 1,05 was associated with ICH, showing a sensitivity of 81.3% and a specificity of 65.9%; the AUC based of the ROC analysis was 0.688 (95% CI 0.570-0.806). CONCLUSION TCCS performed within the first 24 hours after stroke onset can help to predict hemorrhagic transformation in patients with LAO.
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Affiliation(s)
- L Cruz
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - D Damas
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Lourenço
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - A Costa
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - F Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - O Galego
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Nunes
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - R Veiga
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Machado
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - B Rodrigues
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Cecilia
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Almendra
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Bras
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - G Santo
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Machado
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Sargento-Freitas
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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23
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Brito J, Rodigues T, Nunes-Ferreira A, Silverio Antonio P, Couto Pereira S, Valente Silva B, Alves Da Silva P, Barreiros C, Lima Da Silva G, Carpinteiro L, Cortez-Dias N, J Pinto F, Sousa J. Can we use the CHA2DS2VASc score in Atrial Flutter? Europace 2021. [DOI: 10.1093/europace/euab116.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
CHA2DS2VASc score is a well stablished prognostic score in atrial fibrillation population. However, considering patients with isolated atrial flutter no prognostic score are defined, regarding the embolic risk of this population.
Purpose
To evaluate the capacity of CHA2DS2VASc score to predict cardiovascular death and major adverse cardiovascular events (MACE) in flutter patients (pts).
Methods
Single-center retrospective study of pts submitted to CTA between 2015 and 2019, comprising two groups: I – pts with lone AFL; II – patients with AFL and prior AF. Clinical records were analyzed to determine the occurrence of MACE during the long-term follow up, defined as death (of cardiovascular or unknown cause), stroke, clinically relevant bleed or hospitalization due to heart failure or arrhythmic events. CHA2DS2VASc score was categorized into 3 groups: 0-1; 2-3; >4. Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using uni- and multivariate Cox regression analyses.
Results
A total of 476 pts (66 ± 12 years, 80% males) underwent CTA: group I – 284 pts (60%), II – 192 pts (40%). Baseline characteristics were similar between groups, except for age with group I pts being older (68 ± 12, 64 ± 11, p < 0.01). The mean baseline CHA2DS2VASc was 2.3 ± 1.5 and the median post-CTA follow-up was 2.8 year. Considering global population, CHA2DS2VASc score was an independent predictor of cardiovascular death (OR: 1.49 95%CI 1.09-1.79, p = 0.08) and was a predictor of MACE even after adjustment for the diagnose of prior AF (OR 1.88, 95% IC 1.094-3.249, p = 0.022). Considering only the pts in group I CHA2DS2VASc score was a predictor of MACE (OR 3.03, 95% CI 1.112-8.278, p = 0.03) after adjustment for sex and age. Regarding the different MACE components, the score was a predictor of stroke (OR 4.45, IC 1.66-13.39, p = 0.04). In flutter pts CHA2DS2VASc score did not predict cardiovascular death.
Conclusions
In our population CHA2DS2VASc score was able to predict MACE events and stroke in patients with isolated atrial flutter. This suggests that in the future CHA2DS2VASc score could be applied to establish embolic risk in atrial flutter. Abstract Figure.
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Affiliation(s)
- J Brito
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - T Rodigues
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - A Nunes-Ferreira
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - P Silverio Antonio
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - B Valente Silva
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - C Barreiros
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - G Lima Da Silva
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - L Carpinteiro
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - N Cortez-Dias
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - F J Pinto
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
| | - J Sousa
- Santa Maria University Hospital CAML CCHUL, Universidade de Lisboa, Lisbon, Portugal
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24
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Silva BV, Brito J, Rodrigues T, Silverio Antonio P, Couto Pereira S, Alves Da Silva P, Lima Da Silva G, Cunha N, Teixeira P, Carpinteiro L, Cortez -Dias N, Pinto FJ, Sousa J. The pacemaker ventricular lead position and outcomes in patients upgrading to crt. Europace 2021. [DOI: 10.1093/europace/euab116.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Adverse hemodynamic effects of right ventricular pacing are known, and the optimal right ventricular lead position is still being a matter of debate. According to the guidelines, upgrade to cardiac resynchronization therapy (CRT) is recommended in patients with indication for pacemaker and left ventricular ejection fraction less than 50% or who need more than 40% of ventricular pacing.
Purpose
To compare clinical outcomes and ejection fraction in patients with previous pacemaker (apical versus septal right ventricular pacing) who are upgrated to CRT.
Methods
Single-center retrospective study of 94 consecutive patients who had previous pacemaker and upgraded to CRT over a 4-year period. Of these patients, 64 had previous apical lead pacemaker and 30 had previous septal lead pacemaker. Data on comorbidities, New York Heart Association (NYHA), left ventricular ejection fraction and hospitalizations due to heart failure were collected.
The results were obtained using Chi-square, Mann-Whitney and t-test.
Results
Patients with septal pacemaker had significantly more diabetes (p = 0.04) and chronic obstructive pulmonary disease (p = 0.01), tended to be more symptomatic (p = 0.198) and had more days of hospitalization before and after pacemaker implantation (12 ± 3 versus 7 ± 2 days and 8 ± 4 versus 3 ± 1 days, respectively), mostly due heart failure decompensation.
Although there were no significant differences in the initial ejection fraction in patients with apical or septal pacemaker implantation (31.2 ± 1.2% and 29.1 ± 1.5%, respectively, p = 0.323), the time to upgrade to CRT was significantly shorter in patients with septal pacemaker implantation (1999 ± 227 days versus 3005 ± 279 days, p = 0.005).
After upgrading to CRT, patients with apical lead had a significant increase in ejection fraction (8.2%, p = 0.011), while patients with septal lead had a non-significant improvement of ejection fraction (4.5%, p = 0.448). In both, apical and septal lead patients, there was a significant improvement in NYHA class after upgrade to CRT (p = 0.03 and p = 0.02, respectively).
Conclusion
Although patients with septal lead had more comorbidities and hospitalizations due to heart failure, they do not benefit from the upgrade to CRT, unlike what happens in patients with apical lead. These findings can be explained by the fact that the septal lead minimizes ventricular desynchrony induced by right ventricular pacing.
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Affiliation(s)
- BV Silva
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silverio Antonio
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - G Lima Da Silva
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Teixeira
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - L Carpinteiro
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cortez -Dias
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Sousa
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
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25
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Graca Rodrigues TE, Brito J, Silverio-Antonio P, Couto Pereira P, Valente Silva B, Alves Da Silva P, Cunha N, Nunes-Ferreira A, Ribeiro J, Lima Da Silva G, Carpinteiro L, Cortez-Dias N, Pinto FJ, Sousa J. Long-term risk of major cardiovascular events after cavotricuspid isthmus ablation: when and in whom to discontinue oral anticoagulation? Europace 2021. [DOI: 10.1093/europace/euab116.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cavotricuspid isthmus ablation (CTA) is the 1st line therapy to accomplish rhythm control in typical atrial flutter (AFL). Several studies have shown that AFL is frequently associated with AF, which may be silent, posing the patient at risk of systemic embolism. Nowadays, there are no formal recommendations for OAC after CTA in patients with isolated AFL.
Aim
To determine the risk of MACE after CTA and compare: 1) the presence of concomitant AF, 2) concomitantly performing PVI and 3) persistence on OAC.
Methods
Single-center retrospective study of pts submitted to CTA between 2015 and 2019, comprising 3 groups: I – pts with lone AFL; II – patients with AFL and prior AF submitted to CTA only; and III – patients with AFL and prior AF submitted to PVI and CTA. Clinical records were analyzed to determine the occurrence of MACE - death (of CV or unknown cause), stroke, clinically relevant bleed or hospitalization due to HF or arrhythmic events. Long-term OAC was defined as its persistence over 18 months after CTA. Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using uni- and multivariate Cox regression analyses.
Results
A total of 476 pts (66 ± 12 years, 80% males) underwent CTA: group I – 284 pts (60%), II – 109 pts (23%) and III – 83 pts (17%). Baseline characteristics were similar between groups, except for age with group I pts being older (68 ± 12, 67 ± 11, 61 ± 11, p < 0.03). The mean baseline CHA2DS2VASc was 2.3 ± 1.5 and the median post-CTA follow-up was 2.8 year. The 1-, 3- and 5-years MACE risk was 7%, 21% and 32%, respectively and did not differ significantly between groups. OAC was suspended on the long-term in 105 pts (23%), at a mean of 241 days post-CTA. Suspension of OAC was significantly associated with lower MACE risk (HR: 0.26, 95%CI 0.12-0.56, p = 0.001). This effect was independent of the age and CHA2DS2VASc. The prognostic benefit of OAC suspension was driven by the group I and was not verified in patients with concomitant AF. In group I, withdraw of OAC (56 pts - 27%) was associated with a 70% relative risk reduction in the 5-year MACE risk (16% vs 43%, HR: 0.30, 95%CI 0.13-0.69, p = 0.005). In group I, OAC was suspended in patient who were younger (65 ± 11 vs. 69 ± 12, p = 0.002), had lower CHA2DS2VASc (1.9 ± 1.6 vs. 2.7 ± 1.4, p < 0.001) and less often had cerebral vascular disease (1% vs. 8%, p = 0.036), HF (14% vs. 38%, p = 0.001), ischemic cardiomyopathy (9% vs. 19%, p = 0.04) and HTN(61% vs. 75%, p = 0.019).
Conclusions
In pts with AFL submitted to CTA, the long-term risk of MACE is frighteningly high, even in the ones without prior documentation of concomitant AF. Pts with prior AF presenting at the electrophysiological procedure in typical AFL and submitted just to CTA were not significantly harmed, from a prognostic perspective. In pts with lone AFL submitted to successful CTA, it may be reasonable to suspend OAC within 18 months provided that the concomitant AF is carefully excluded. Abstract Figure.
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Affiliation(s)
- TE Graca Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silverio-Antonio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Couto Pereira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - B Valente Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Nunes-Ferreira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Ribeiro
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - G Lima Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - L Carpinteiro
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cortez-Dias
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Sousa
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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26
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Sousa J, Matos D, Ferreira A, Abecasis J, Saraiva C, Freitas P, Carmo J, Carvalho S, Rodrigues G, Durazzo A, Costa F, Carmo P, Morgado F, Cavaco D, Adragao P. Epicardial adipose tissue and atrial fibrillation: guilty as charged or guilty by association? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Epicardial adipose tissue (EAT) has been linked to the presence and burden of atrial fibrillation (AF). However, it is still unclear whether this relationship is causal or simply a surrogate marker of other risk factors commonly associated with AF.
Purpose
The purpose of this study was to assess the relationship between these factors and EAT, and to compare their performance in predicting AF recurrence after an ablation procedure.
Methods
We assessed 575 consecutive patients (mean age 61±11 years, 62% male) undergoing AF ablation preceded by cardiac CT in a high-volume ablation center. EAT was measured on cardiac CT using a modified simplified method. Patients were divided into 2 groups (above vs. below the median EAT volume). Cox regression was used to assess the relationship between epicardial fat, risk factors, and AF relapse.
Results
Patients with above-median EAT volume were older (p<0.001), more often male (OR 1.7, p=0.002), had higher body mass index, and higher prevalence of smoking, hypertension, diabetes and dyslipidemia (p<0.05). Non-paroxysmal AF was also more common in those with above-median EAT volume. During a median follow-up of 18 months, 232 patients (40.3%) suffered AF recurrence. After adjustment for BMI and other univariate predictors of relapse, three variables emerged independently associated with time to AF recurrence: non-paroxysmal AF (HR 2.1, 95% CI: 1.5–2.7, p<0.001), indexed left atrial (LA) volume (HR 1.006 per mL/m2, 95% CI: 1.002–1.011, p<0.001), and indexed epicardial fat volume (HR 1.87 per mL/m2, 95% CI: 1.66–2.1, p<0.001). None of the classic cardiovascular risk factors were an independent predictor of AF recurrence (all p>0.10).
Conclusion
Classic cardiovascular risk factors are more prevalent in patients with higher amounts of epicardial fat. However, unlike these risk factors, EAT is a powerful predictor of AF recurrence after ablation. These findings suggest that EAT is not merely a surrogate marker, but an important participant in the pathophysiology of AF.
EAT, cvrf and AF burden
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Sousa
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - D Matos
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - A Ferreira
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - J Abecasis
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - C Saraiva
- Hospital de Santa Cruz, Radiology, Lisbon, Portugal
| | - P Freitas
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - J Carmo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - S Carvalho
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - G Rodrigues
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - A Durazzo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - F.M Costa
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - P Carmo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - F Morgado
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - D Cavaco
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - P Adragao
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
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Lopes J, Saleiro C, Campos D, Sousa J, Puga L, Gomes A, Ribeiro J, Lourenco C, Silva J, Goncalves L. Gender in non- ST elevation myocardial infarction and unstable angina: is there any equality? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Historically, women (W) with acute coronary syndrome (ACS) have worse outcomes compared with men (M). This fact may occur due to gender-specific differences in the presentation and management of patients (P), which were mainly observed in studies dealing with ST-segment elevation infarction (STEMI). There seems to be a gap of knowledge in gender-specific differences in non- ST elevation myocardial infarction (NSTEMI) and unstable angina (UA).
Purpose
Assess gender-specific differences in presentation, treatment and outcomes in NSTEMI and UA patients.
Methods
A retrospective cohort study from consecutive ACS patients enrolled in a multicentre national registry from October 2010 to December 2018 was conducted, identifying 11394 P admitted with NSTEMI or UA. Demographic, clinical and treatment variables were compared between male gender and female gender P.
A Cox multivariate regression was performed to evaluate predictor factors of stablished endpoints: mortality at 1-year (1y) and cardiovascular (CV) hospitalization at 1-year.
Results
A total 11394 P were included, 8145 M (71.5%) and 3249 W (28.5%), mean age of 68±13. W, comparing with M, had higher age (72±12 vs 66±13, p=0.001), higher prevalence of hypertension (85% vs 72%, p=0.001) and diabetes (41% vs 34%, p=0.001) and longer time from symptoms to hospital admission (360 minutes vs 297 minutes, p=0.001). Chest pain was less frequent as first symptom in W (85.6% vs 91.3%, p=0.001). In medical treatment, W had higher chance of not having administration of a loading dose of P2Y12 inhibitor (22.1% vs 18.1, p=0.001) and of being medicated with clopidogrel (85.7% vs 82.1%, p=0.002). At discharge, W were less frequently medicated with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (82.6% vs 84.4, p=0.028). Coronary angiography was less frequently performed in W (77.3% vs 85.7%, p=0.001). Coronary artery disease was less frequently found in the female gender (12.4% vs 4.8%, p=0.001).
In-hospital mortality was higher in W (2.9% vs 2.1%), but in the multivariate analysis the female gender was not an independent predictor of in-hospital mortality (OR 1.05 [0.67- 1.65], p=0.823). 1-year mortality was higher in W (9.2% vs 7.3%) and 1-year CV hospitalization was higher in M (16.8% vs 14.4%). After adjusting for covariates in Cox regression analysis, difference was still significant for mortality (HR= 1.274 [1.038 - 1.564], p=0.02) and hospitalization (HR = 0.852 [0.726- 0.998], p=0.047).
Conclusion
In this NSTEMI and UA cohort, there are important gender-specific differences in comorbidities, diagnosis, management and outcomes. Gender was an independent predictor of 1-year mortality and 1-year CV hospitalization, but not an independent predictor for in-hospital mortality.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Saleiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - D Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Sousa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Gomes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Ribeiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Lourenco
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Silva
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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28
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Sousa J, Carmo J, Matos D, Rodrigues G, Ferreira A, Alencar J, Klemtz F, Durazzo A, Carvalho S, Costa F, Carmo P, Parreira L, Morgado F, Cavaco D, Adragao P. Catheter ablation in atrial fibrillation: comorbidities and mortality from high-volume centers. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Catheter ablation (CA), has gained wider acceptance as an attractive option for treating symptomatic AF. Although traditionally seen as a safe procedure, there is limited and conflicting data on procedure-related early morbimortality, with new evidence suggesting early mortality may be as high as 0.5%-1%.
Purpose
We aimed to assess the rates of early and late morbimortality of post-atrial fibrillation (AF) ablation in high-volume centers.
Methods
Prospective registry of 2 high-volume ablation centers, comprising 3722 consecutive patients (mean age 61.1±11.2, 66.4% male, n=2471), who underwent AF ablation from 2005 to 2019. Early mortality was defined as death during initial admission or during the first 45 days after ablation. Median follow-up time was 5.4 years.
Results
Most patients were treated with radiofrequency (97%) while 3% were treated with cryoablation. Early mortality was 0.08% (n=3), with a median time from ablation to death of 22 days. Cumulative mortality at 3, 6 and 12 months was 0.08%, 0.16% and 0.19%, respectively. At 3 and 5 years, mortality remained low at 0.48% and 0.73%, respectively. Early mortality was higher among patients who had suffered procedural complications (fistula and stroke, p<0.001). Among the latter, pericardial effusion and tamponade were the most frequently found (0.6%, n=24), only 1 of which required emergent surgical drainage and myocardial repair. Early ischemic stroke occurred in 2 patients (0.1%). Other less frequent complications were atrio-esophageal fistula (0.1%, n=2), phrenic nerve palsy (0.1%, n=2), anoxic encephalopathy following cardiac arrest (0.03%, n=1) and pulmonary vein stenosis (0.03%, n=1).
Conclusion
Early mortality following ablation is very low (<0.1%), when performed by an experienced high-volume team. Severe complications are rare (<1%) and mostly amenable to treatment. Our findings reaffirm the overall safety of AF ablation.
AF catheter ablation morbimort
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Sousa
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - J Carmo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - D Matos
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - G Rodrigues
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - A Ferreira
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - J Alencar
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - F Klemtz
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - A Durazzo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - S Carvalho
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - F.M Costa
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - P Carmo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - L Parreira
- Hospital da Luz, SA, Cardiology, Lisbon, Portugal
| | - F Morgado
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - D Cavaco
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - P Adragao
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
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29
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Moniz Mendonca F, Mendonca M, Pereira A, Monteiro J, Sousa J, Santos M, Temtem M, Sousa A, Henriques E, Freitas S, Freitas A, Freitas D, Reis P. Has the time come to integrate genetic risk scores into clinical practice? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The risk for Coronary Artery Disease (CAD) is determined by both genetic and environmental factors, as well as by the interaction between them. It is estimated that genetic factors could account for 40% to 55% of the existing variability among the population (inheritability). Therefore, some authors have advised that it is time we integrated genetic risk scores into clinical practice.
Aim
The aim of this study was to evaluate the magnitude of the association between an additive genetic risk score (aGRS) and CAD based on the cumulative number of risk alleles in these variants, and to estimate whether their use is valuable in clinical practice.
Methods
A case-control study was performed in a Portuguese population. We enrolled 3120 participants, of whom 1687 were CAD patients and 1433 were normal controls. Controls were paired to cases with respect to gender and age. 33 genetic variants known to be associated with CAD were selected, and an aGRS was calculated for each individual. The aGRS was further subdivided into deciles groups, in order to estimate the CAD risk in each decile, defined by the number of risk alleles. The magnitude of the risk (odds ratio) was calculated for each group by multiple logistic regression using the 5th decile as the reference group (median). In order to evaluate the ability of the aGRS to discriminate susceptibility to CAD, two genetic models were performed, the first with traditional risk factors (TRF) and second with TRF plus aGRS. The AUC of the two ROC curves was calculated.
Results
A higher prevalence of cases over controls became apparent from the 6th decile of the aGRS, reflecting the higher number of risk alleles present (see figure). The difference in CAD risk was only significant from the 6th decile, increasing gradually until the 10th decile. The odds ratio (OR) for the last decile related to 5th decile (median) was 1.87 (95% CI:1.36–2.56; p<0.0001). The first model yielded an AUC=0.738 (95% CI:0.720–0.755) and the second model was slightly more discriminative for CAD risk (AUC=0.748; 95% CI:0.730–0.765). The DeLong test was significant (p=0.0002).
Conclusion
Adding an aGRS to the non-genetic risk factors resulted in a modest improvement in the ability to discriminate the risk of CAD. Such improvement, even if statistically significant, does not appear to be of real value in clinical practice yet. We anticipate that with the development of further knowledge about different SNPs and their complex interactions, and with the inclusion of rare genetic variants, genetic risk scores will be better suited for use in a clinical setting.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - A Pereira
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - J Monteiro
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - J Sousa
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - M Santos
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - M Temtem
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - A.C Sousa
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - E Henriques
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - S Freitas
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - A.I Freitas
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - D Freitas
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - P Reis
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Sousa J, Monteiro J, Mendonca F, Santos M, Temtem M, Neto M, Alves J, Andrade G, Pereira A, Freitas S, Pereira D, Mendonca M, Freitas A. KAsH score beyond myocardial infarction: a new risk stratification tool for myocardial injury? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Our group has recently validated and published a new score - KAsH score. KAsH consists of a continuous, multiplicative score based on 4 simple clinical variables available at first medical contact, proven to be a robust predictor of in-hospital mortality and all-cause mortality at 1 year follow-up in patients with myocardial infarction, putting it next to other well established risk scores. However, the role of KAsH in patients with myocardial injury (Mi), a largely uncharacterized group in the literature, remains unknown.
Purpose
We aim to assess the predictive power of KAsH in patients with myocardial injury (Mi), regarding in-hospital mortality and at 1 year follow-up.
Methods
Prospective registry of 250 patients admitted consecutively through the emergency department from January 2018 onward, with higher than P99th high-sensitive troponin assay. The kit used was Roche's Elecsys hsSTAT, and the P99th appointed by the manufacturer was 14 ng/L. All patients with chronic kidney disease ClCr<15ml/min and myocardial infarction, were excluded from the analysis. We were left with 236 patients diagnosed with Mi.
KAsH = (Killip Kimbal × Age × Heart Rate) / Systolic BP
We used a simplified Killip classification: without heart failure (1 point), with heart failure (2 points) and in shock (3 points). We assessed the score's association to mortality and its predictive value through ROC curves and their respective area under the curve (AUC).
Results
Both Killip and KAsH had a significant and positive association with in-hospital mortality (KK: p=0.02; KAsH: p<0.001) and cumulative mortality (KK: p=0.002; KAsH: p=0.008). In multivariate analysis, KAsH score as a continuous variable proved to be an independent predictor of in-hospital mortality (p=0.004) but not KK classification (p=0.96). We then categorized KAsH in its 4 different strata (1–4). Multivariate analysis indentified categorized KAsH as the only significant predictor of in-hospital mortality (OR 4.1, CI 2.1–8.1, p<0.001), with the predictive power of KAsH being even mildly superior (AUCs: KAsHcont 0.767, KAsHcat 0.743, KK 0.685). However, the same trend was not observed during follow-up, as none of them were significant predictors of mortality (all p>0.1).
Conclusions
KAsH seems to maintain its in-hospital predictive value even in patients with Mi. To our knowledge, this is the first study that tries to apply risk scores and stratification tools to such a heterogeneous group of patients. By comprising hemodynamic variables, KAsH may actually be a better risk stratification tool than just the severity of heart failure on admission. However, unlike previously proven in myocardial infarction (MI), KAsH score and its hemodynamic variables do not seem to justify the high mortality on the long run behind these patients. More studies will be needed to address the complex causes behind long-term mortality of Mi patients.
KASH table graph
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Sousa
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - J.P Monteiro
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - F Mendonca
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - M Santos
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - M Temtem
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - M Neto
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - J Alves
- Hospital Dr. Nelio Mendonca, Clinical Pathology, Funchal, Portugal
| | - G Andrade
- Hospital Dr. Nelio Mendonca, Clinical Pathology, Funchal, Portugal
| | - A Pereira
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - S Freitas
- Hospital Central do Funchal, Drª. Mª Isabel Mendonça Investigation Unit, Funchal, Portugal
| | - D.H Pereira
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - M.I Mendonca
- Hospital Central do Funchal, Drª. Mª Isabel Mendonça Investigation Unit, Funchal, Portugal
| | - A.D Freitas
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
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Lopes J, Monteiro M, Campos D, Saleiro C, Costa S, Sousa J, Puga L, Gomes A, Silva J, Ferreira M, Goncalves L. Isolated apical perfusion defect in SPECT-CT scans, is there any prognostic value? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial perfusion imaging (MPI) plays a significant role in diagnostic and therapeutic decision making in coronary artery disease (CAD). An isolated apical defect in the 17th segment in SPECT/CT scans is a common finding, sometimes attributed to the apical thinning phenomenon. However, the clinical significance of apical thinning or other isolated apical defects is unknown.
Purpose
The purpose of this study is to assess the prognostic impact of an isolated apical perfusion defect (17th segment) in patients (P) with suspicion of significant CAD.
Methods
A cohort of 612 consecutive P that underwent a MPI test with a SPECT/CT scanner, between January 2017 and December 2017, in a single nuclear medicine centre, was included in this retrospective study.
The inclusion criteria for this study were either a normal perfusion exam (group 1 – G1) or only an isolated apical defect in the 17th segment, either reversible suggesting ischemia (group 2 – G2) or fixed suggesting necrosis (group 3 – G3). Images with and without attenuation correction were analysed. Mean follow-up was 29±4 months.
The chi square test was used for categorical variables, and analysis of variance for continuous variables. Binary logistic regression was used to control for confounding.
Results
A total of 612 P were included (57% male sex, mean age of 69±10) and divided in G1 (n=494, 80.7%), G2 (n=62, 10%) and G3 (n=56, 9.2%). P in G3 had higher body mass index (31±7, p=0.028) and higher prevalence of dyslipidemia (84%, p=0.001), while P in G1 had lower ejection fraction at rest (54±15, p=0.001). There was no association between the presence of isolated apical defect and all- cause mortality (G1 = 7.3% vs G2 = 6.5% vs G3 = 5.4%, p=0.851). There was a statistically significant difference between groups in the referral for coronary angiography in the bivariate analysis (G1 = 7.9% vs G2 = 35.5% vs G3 = 10.7%, p=0.001), but this association did not remain when accounted for potential confounders (angina, ejection fraction, previous CAD and diabetes) – OR=3.94, 95% CI: [0.968–16.093], p=0.056.
In those P that underwent coronary angiography, there was no statistically significant difference between the 3 groups in revascularization of significant CAD (G1 = 38.5% vs G2 = 36.4% vs G3 = 50%, p=0.830). During the follow-up time, 11 P of group 1 suffered an acute coronary syndrome (ACS), but there were no events in group 2 or 3.
Conclusion
Isolated apical myocardial defect on a SPECT/CT exam has no association with all-cause mortality in this patients. There is no significant difference in referral for coronary angiography or need for coronary revascularization between P with normal exams and P with isolated apical defects.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M Monteiro
- University Hospitals of Coimbra, Nuclear Medicine, Coimbra, Portugal
| | - D Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Saleiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - S Costa
- University Hospitals of Coimbra, Internal Medicine, Coimbra, Portugal
| | - J Sousa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Gomes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Silva
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Lopes J, Saleiro C, Campos D, Sousa J, Puga L, Gomes R, Ribeiro J, Silva J, Goncalves L. P1092Syncope in the emergency department: can 24-hour holter monitoring be of any help? Europace 2020. [DOI: 10.1093/europace/euaa162.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Syncope is a very common reason for presenting to the emergency department (ED). The existence of a telemetry unit is crucial but it is not the reality in some hospitals. In order to avoid unnecessary ward admission, 24-hour Holter (24HH) monitoring could be useful to help with the diagnosis (when the arrhythmic etiology is suspected and the symptoms are frequent enough) and also be important to safely discharge a patient.
Purpose
The purpose of this study is to evaluate the diagnostic performance of 24HH monitoring, during a syncope episode in the ER, and to compare the readmission rates between patients with normal and abnormal not diagnostic 24HH monitoring.
Methods
A cohort study of consecutive patients (P) who were monitored with 24HH in one hospital in the ED, between January 2015 and December 2017, were included. All the 24HH results were seen by a senior cardiologist and divided in three groups: A - normal, B - abnormal Holter study unlikely to explain syncope and C- Holter study considered to be diagnostic.
Groups A and B were compared using chi-square independence test to evaluate association between the result of the 24HH and readmission rates at 30 days and 1 year, as well as mortality and device implantation at 1 year. Multivariate logistic regression was used to look for other confounders.
Results
A total of 111 P were included in this study. Mean age was 75 ± 14 years old, with 55.6% male patients.
A previous emergency episode with syncope was present in 56.9% of P. The mortality at one-year follow-up was 11.9%. The 24HH was considered diagnostic in 25.2% of P (28 P), with 18.9% of all the P with necessity of pacemaker (PM) implantation. In the patients with a non-diagnostic 24HH, 6,4% implanted a loop recorder before discharge.
Group B patients had a higher 30-day readmission rate to the ED when compared with group A (OR = 4.050 CI 95 [1.13 – 14.497], p = 0.033), but no difference in one-year readmission rate (p= 0.065). There was no difference in one-year mortality between the two groups (p= 0.731) or in one-year implantation of pacemaker (p= 0.431).
Conclusion
The use of 24HH in the ED could be a valuable tool in the diagnosis of rhythm disorders that cause syncope. An abnormal non diagnostic result can still be a predictor of 30-day readmission to the ED with similar complaints.
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Affiliation(s)
- J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Saleiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - D Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Sousa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Gomes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Ribeiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Silva
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Mourato C, Corpuz A, Sousa J, Martins D, Pereira C, Tomaz J, Barreira R, Rocha C, Mendes F. Forssman Prevalence in a Portuguese Donor Population. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction Discovered in 1911 by Frederick Forssman, the Forssman (Fs) antigen (Ag) expression varies among species, being rarely present on human red blood cells (RBC). In 1987 three unrelated English families were identified with a phenotype designed Apae which was later classified as the 31st blood group: FORS. Since antibodies (Ab) anti-Fs has natural occurrence and the expression of the Ag occurs on the surface of the RBC, body fluids and organs, raises a potential role for this antigen in transfusion and transplantation implications.
Objectives Our main goals were to evaluate the prevalence of anti-Fs Ab and clarify its impact in transfusional medicine by classifying the type of immunoglobulin (Ig) involved.
Methodology 3-5% sheep RBC suspension with positive expression for Fs Ag was used to evaluate the presence of Ab anti-Fs in plasma samples from a Portuguese population of blood donor and classify the immunoglobulin involved. Standard tube technique was used in all the experiments.
Results From a total of 11877 donors, 117 (0,99%) showed weak reactions (between 0 and 1 in a scale from 0 to 4). All these samples would be further studied to evaluate the presence of the Arg296Gln in the GBGT1 gene. Also, from the 192 samples studied to classify the Ab involved, 52% revealed to be only IgM, being the rest a mixture between IgG and IgM.
Conclusion The population studied revealed few samples with negative reaction against the sheep RBC confirm the low-prevalence of this blood group. The majority from the Ab to be IgM was also corroborated although the presence of an IgG portion can be clinically significant once it can cross the placental barrier.
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Affiliation(s)
- C Mourato
- Instituto Politécnico de Coimbra, ESTeSC – Coimbra Health School, Ciências Biomédicas Laboratoriais, Portugal
| | - A Corpuz
- School of Biological Sciences, Dublin Institute of Technology, Kevin St, Dublin 8, Ireland
| | - J Sousa
- Instituto Politécnico de Coimbra, ESTeSC – Coimbra Health School, Ciências Biomédicas Laboratoriais, Portugal
| | - D Martins
- Instituto Politécnico de Coimbra, ESTeSC – Coimbra Health School, Ciências Biomédicas Laboratoriais, Portugal
- I3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - C Pereira
- Blood Bank Service, Coimbra Hospital and University Center, Coimbra, Portugal
| | - J Tomaz
- Blood Bank Service, Coimbra Hospital and University Center, Coimbra, Portugal
| | - R Barreira
- Instituto Politécnico de Coimbra, ESTeSC – Coimbra Health School, Ciências Biomédicas Laboratoriais, Portugal
- Blood Bank Service, Coimbra Hospital and University Center, Coimbra, Portugal
| | - C Rocha
- Instituto Politécnico de Coimbra, ESTeSC – Coimbra Health School, Ciências Complementares, Portugal
| | - F Mendes
- Instituto Politécnico de Coimbra, ESTeSC – Coimbra Health School, Ciências Biomédicas Laboratoriais, Portugal
- CNC.IBILI Consortium/Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
- Biophysics Institute, Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Portugal Foundation for Science and Technology (FCT), Portugal (Strategic Projects UID/NEU/04539/2013 and UID/NEU/04539/2019) and COMPETE-FEDER (POCI-01-0145-FEDER-007440)
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Graca Rodrigues TE, Nunes-Ferreira A, Cunha N, Santos R, Aguiar-Ricardo I, Rigueira J, Silverio Antonio P, Pereira SC, Morais P, Bernardes A, Pinto FJ, Sousa J, Marques P. P1162Atrial fibrillation and Cardiac resynchronization therapy - is this combination truly bad? Europace 2020. [DOI: 10.1093/europace/euaa162.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cardiac resynchronization therapy (CRT) significantly reduces mortality and hospitalizations in patients with heart failure and reduced ejection fraction (EF). Atrial fibrillation (AF) is a very common comorbidity in these patients, however, CRT benefit in AF patients has been controversial.
Purpose
To compare the prognostic impact of CRT in patients (pts) with and without AF.
Methods
Prospective, single-center study that included pts undergoing CRT implantsince 2015. Clinical and echocardiographicevaluation were made before CRT implant and between 6-12 months post-implant. Pts with EF elevation ≥10% or LV end-systolic volume (ESV) reduction ≥15% were classified as responders. Patients with EF elevation ≥ 20% or ESV reduction ≥30% were classified as super-responders. All the parameters were compared between patients with and without AF.Prognostic impact of CRT was evaluated by comparing total mortality using the Cox regression and Kaplan-Meier methods.
Results
From 2015-2019, 566 CRTs were implanted (26.1% female, 72 ± 10.2 years old, follow-up duration 18.9 ± 15.8 months). From these patients, 166 patients (31%) had AF (73.5% males, mean age 72.2 ± 10.2 years, 37.3% ischemic, LVEF < 30% in 65.5%). The cardiovascular risk factors and comorbidities were similar in both populations (with and without AF), except for chronic kidney disease which was more frequent in AF pts(28% vs 17%, p = 0.012).
The prevalence of complications and surgical revision were similar in both groups.
The CRT response rate was similar in both groups (50% in AF group vs 59.6%, p = NS) as was the super-response rate (22.4% in FA pts vs 31.5%, p = NS).
The 4-year survival rate of patients with AF was similar to non-AF (83.7% vs 84.3%).
Conclusion
Despite the controversy about the efficacy of CRT in AF pts, in our population the long-term survival and CRT response rates were comparable between patients with and without AF.
Abstract Figure.
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Affiliation(s)
- T E Graca Rodrigues
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - A Nunes-Ferreira
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - N Cunha
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - R Santos
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - J Rigueira
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - P Silverio Antonio
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - S C Pereira
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - P Morais
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - A Bernardes
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - F J Pinto
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - J Sousa
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
| | - P Marques
- Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon School of Medicine, Lisboa, Portugal, Universidade de Lisboa, Lisbon, Portugal
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Lopes J, Teixeira R, Campos D, Saleiro C, Sousa J, Puga L, Ribeiro J, Silva J, Goncalves L. P1433Prevalence and location of residual leaks following percutaneous left atrial appendage occlusion: the importance of 3D transesophageal echocardiography. Europace 2020. [DOI: 10.1093/europace/euaa162.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The left atrial appendage (LAA) shape and size are very variable, and incomplete appendage closure or persistent leaks around the device are common following device placement. Limited studies reported the rate of peri-device leaks (PDL) after percutaneous left atrial appendage closure, and the impact of 3D transesophageal echocardiography (3D-TEE) on the detection of those leaks.
Aim
To describe the rate and location of leaks 1 month after percutaneous closure of the LAA, with and without the use of 3D-TEE.
Methods
A cohort study of consecutive patients (P) who were submitted to a percutaneous LAA closure with success in one interventional cardiology centre, between May 2010 and October 2018, were included. Clinical and echocardiography data were recorded and analysed. Two groups were created: Group A (GA) included patients until August 2015 submitted to 2D TEE on follow up (N= 48) versus Group B (GB), which was composed of patients submitted to 3D-TEE after August 2015 (N= 76).
Results
A total of 124 P had an in-hospital admission for LAA closure, with control TEE 1 month after the procedure. Mean age was 73 ± 7 years old, with 62.9% male patients. The procedure was guided by TEE (52%) or intra cardiac echocardiography (ICE) (48%).Transeptal puncture was preferred (95% of the procedures). The most used device was Amulet (62%) vs ACP (23%) and Watchman (15%).
In the follow up TEE, 20% of patients had only 1 leak and 2% had 2 leaks. Of the detected leaks,31% were considered minor (< 1 mm), 35% moderate (1-3 mm) and 34% major (> 3 mm). Patients with leaks had a larger LAA diameter (22 ± 4 mm vs. 17 ± 3 mm, P = 0.01).
Of the detected leaks, 50% were located in the superior portion of the device, 23% were located in the inferior portion, 8% in the posterior portion and 8% in the lateral portion.
In GA the rate of leaks was 14% vs 24.5% in GB, with differences also when specified the size of the leak – minor (GA 2% vs GB 8.8%), moderate (GA 8% vs GB 8.1%) and major (GA 4% vs GB 7.6%).
Conclusion
The use of 3D echocardiography, 1 month after successful percutaneous LAA closure, augmented the rate of detection of device leaks. It remains to be studied the clinical impact of this finding.
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Affiliation(s)
- J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Teixeira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - D Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Saleiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Sousa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Ribeiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Silva
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Vieira L, Ribeiro L, Guimarães D, Sousa J, Varanda A. Lisbon Burn Centre experience with intentional burn injuries. Ann Burns Fire Disasters 2020; 33:14-19. [PMID: 32523490 PMCID: PMC7263718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/01/2020] [Indexed: 06/11/2023]
Abstract
Burn injury as a form of hetero or auto-aggression accounts for a significant amount of admissions to a Burn Care Unit, with epidemiologic and clinical specificities. To investigate the differences in risk factors, psychiatric comorbidities, injury severity and mortality among adult patients with accidental or intentional burns, we analyzed routinely collected data from a Central Hospital Burn Unit over a period of 6 years (January 1st, 2010 to December 31st, 2015). We identified 22 intentional burn patients (5%) among all the admissions to our Burn Unit. When compared to the accidental burns, the intentional burn patients are significantly younger (45.7±14.7 vs. 54.9±19.9), have a bigger percentage of body surface area burned (35% vs. 14%), have a higher incidence of inhalation burn (50% vs. 22.8%) and higher mortality (18.2% vs. 6.1%). Fifty-five percent of cases of intentional burns were self-inflicted. Self-inflicted burns have a worse prognosis than hetero-aggressions (inhospital mortality 25% vs. 10%). Psychiatric comorbidities were largely more prevalent in the intentional burn patients (59% vs. 6.6%), namely mood disorders. Compared to patients with accidental burns, intentional burn patients have worse clinical condition and prognosis. A multidisciplinary preventive approach, looking at the specificities of the violent nature of the lesions and identifying risk groups may reduce the incidence and severity of this type of burns.
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Affiliation(s)
- L. Vieira
- Luís Vieira, MD
Plastic and Reconstructive Surgery Department, Centro Hospitalar Lisboa CentralRua José António Serrano - 1150-199 LisbonPortugal+351 918055441
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De Campos D, Teixeira R, Botelho A, Saleiro C, Lopes J, Puga L, Ribeiro JM, Sousa J, Goncalves L. P1391 Global longitudinal strain in chronic asymptomatic aortic regurgitation: a meta-analysis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND Previous studies have shown that left ventricle global longitudinal strain (GLS) assessed with 2D-speckle tracking echocardiography, is an independent predictor of outcome in asymptomatic moderate to severe chronic aortic regurgitation (AR) patients.
OBJECTIVES
To assess GLS impact on mortality and need for aortic valve replacement (AVR) or symptom development in chronic asymptomatic AR patients and preserved left ventricular ejection fraction (LVEF).
METHODS A literature search was performed according with these key terms "aortic regurgitation" and "longitudinal strain." The primary endpoint was all-cause mortality. Secondary end-points were: a composite of all-cause mortality, need for AVR or symptom development; and only AVR plus symptom development. Data was pooled using random-effects meta-analysis models. Pooled Hazard Ratio (HR) was performed using its log transformation and inverse variances as weights were then calculated for each study .
RESULTS Six studies were included, with a total of 1,571 asymptomatic patients with at least moderate AR and preserved LVEF. There were 996 events (death, AVR, symptom development) reported during follow-up. Pooled adjusted mortality HR tended to be higher for patients with worse GLS (1.14 [0.96–1.35], P = 0.13, I2 51%). GLS performed better in predicting AVR or symptom development (mean difference -0.72 [-1.29, -0.15], P = 0.01, I2 88%), with an estimated HR of 1.36 ([1.01–1.84], P = 0.04, I2 65%).
CONCLUSIONS In asymptomatic chronic moderate to severe AR patients, impaired GLS was associated with adverse cardiac outcomes. Left ventricular GLS may offer incremental value on risk stratification as well as on decision-making.
Abstract P1391 Figure 1
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Affiliation(s)
- D De Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Teixeira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Botelho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Saleiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J M Ribeiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Sousa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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De Campos D, Saleiro C, Teixeira R, Botelho A, Lopes J, Puga L, Ribeiro JM, Sousa J, Lourenco C, Reis L, Madeira M, Goncalves L. 571 Echo-Omics to estimate prognosis after an acute myocardial infarction: which one to pic? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
Simple and reproducible echocardiographic parameters are still the cornerstone of daily clinical practice. These data provides important information for the evaluation of patients with ST-segment elevation myocardial infarction (STEMI). The identification of prognostic echocardiographic parameters in STEMI would help in risk stratification.
PURPOSE
To evaluate the discriminatory capacity of echocardiographic parameters after a STEMI.
METHODS
Single centre retrospective observational study of 303 patients with STEMI who survived hospital stay and had a complete echocardiographic evaluation. The following ecocardiographic parameters were collected at discharge: left ventricular (LV) systolic and diastolic volumes; septal and posterior wall thickness; LV ejection fraction (LVEF); left atrial (LA) diameter; estimated systolic pulmonary artery pressure (SPAP). One year and long-term all cause mortality were analyzed.
RESULTS
For the patients enrolled (71% males, 64.6 ± 14.1 years old), peak troponin I was 99.1 ± 126.5 ng/mL; mean GRACE score was 153.6 ± 38.8 points and mean LVEF was 46.2 ± 11.2%. One year mortality was 8.3% and during a median 73 months follow-up, 25.1% patients were deceased. After adjustment for echocardiographic variables in a Cox regression model, SPAP (HR 1.07, 95%CI 1.02-1.12, P = 0.007) and septal thickness (HR 1.36, 95%CI 1.08-1.73, P = 0.01) were both independently associated with one year mortality. A Kaplan-Meier survival methodology using stratified SPAP and septal thickness showed a trend of different event rate (log rank P = 0.003 and P = 0.035, respectively), with a gradation of cumulative risk for all-cause mortality, with a sharp increase at >40mmHg and >11mm, respectively. Regarding longterm follow-up, only increased SPAP proved to be an independent predictor of mortality (HR 1.04, 95%CI 1.01-1.08, P = 0.016). The difference in favor of an SPAP <33mmHg (sensitivity 86.67% and specificity 54.1%) was seen early after the STEMI event and maintained at each interim analysis (log rank P = 0.002). Upon the visual analysis of the cubic spline curves, patients with SPAP < ± 30mmHg had a good long-term survival. No association of LV volumes or LVEF was noted for both one year and long-term mortality.
CONCLUSION
Classic echocardiographic parameters still have a role to estimate prognosis after STEMI. Estimated SPAP had the greatest discriminatory capabilities, surpassing left ventricular ejection fraction!
Abstract 571 FIGURE 1
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Affiliation(s)
- D De Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Saleiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Teixeira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Botelho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J M Ribeiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Sousa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Lourenco
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Reis
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M Madeira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Virk HS, Rekas MZ, Biddle MS, Wright AKA, Sousa J, Weston CA, Chachi L, Roach KM, Bradding P. Validation of antibodies for the specific detection of human TRPA1. Sci Rep 2019; 9:18500. [PMID: 31811235 PMCID: PMC6898672 DOI: 10.1038/s41598-019-55133-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/22/2019] [Indexed: 12/26/2022] Open
Abstract
The transient receptor potential cation channel family member ankyrin 1 (TRPA1) is a potential target for several diseases, but detection of human TRPA1 (hTRPA1) protein in cells and tissues is problematic as rigorous antibody validation is lacking. We expressed hTRPA1 in a TRPA1-negative cell line to evaluate 5 commercially available antibodies by western blotting, immunofluorescence, immunocytochemistry and flow cytometry. The three most cited anti-TRPA1 antibodies lacked sensitivity and/or specificity, but two mouse monoclonal anti-TRPA1 antibodies detected hTRPA1 specifically in the above assays. This enabled the development of a flow cytometry assay, which demonstrated strong expression of TRPA1 in human lung myofibroblasts, human airway smooth muscle cells but not lung mast cells. The most cited anti-TRPA1 antibodies lack sensitivity and/or specificity for hTRPA1. We have identified two anti-TRPA1 antibodies which detect hTRPA1 specifically. Previously published data regarding human TRPA1 protein expression may need revisiting.
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Affiliation(s)
- H S Virk
- Department of Respiratory Sciences, University of Leicester, UK Institute of Lung Health and NIHR Leicester BRC-Respiratory, Leicester, United Kingdom.
| | - M Z Rekas
- Department of Respiratory Sciences, University of Leicester, UK Institute of Lung Health and NIHR Leicester BRC-Respiratory, Leicester, United Kingdom
| | - M S Biddle
- Department of Respiratory Sciences, University of Leicester, UK Institute of Lung Health and NIHR Leicester BRC-Respiratory, Leicester, United Kingdom
| | - A K A Wright
- Department of Respiratory Sciences, University of Leicester, UK Institute of Lung Health and NIHR Leicester BRC-Respiratory, Leicester, United Kingdom
| | - J Sousa
- Department of Respiratory Sciences, University of Leicester, UK Institute of Lung Health and NIHR Leicester BRC-Respiratory, Leicester, United Kingdom
| | - C A Weston
- Department of Respiratory Sciences, University of Leicester, UK Institute of Lung Health and NIHR Leicester BRC-Respiratory, Leicester, United Kingdom
| | - L Chachi
- Department of Respiratory Sciences, University of Leicester, UK Institute of Lung Health and NIHR Leicester BRC-Respiratory, Leicester, United Kingdom
| | - K M Roach
- Department of Respiratory Sciences, University of Leicester, UK Institute of Lung Health and NIHR Leicester BRC-Respiratory, Leicester, United Kingdom
| | - P Bradding
- Department of Respiratory Sciences, University of Leicester, UK Institute of Lung Health and NIHR Leicester BRC-Respiratory, Leicester, United Kingdom
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Sousa J, Mendonca M, Pereira A, Mendonca F, Monteiro J, Neto M, Sousa AC, Henriques E, Freitas S, Guerra G, Borges S, Ornelas I, Drumond A, Palma Dos Reis R. P3399Influence of TCF21 rs12190287 in the coronary artery disease risk prediction. An association study in a Portuguese population. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
TCF21 is a member of the basic-helix-loop-helix (bHLH) transcriptor factor family, being critical for embryogenesis of the heart, kidney and spleen. TCF21 also regulates epicardium-derived cells differentiation into smooth muscle and fibroblast lineages.
Aim
Investigate the impact of TCF21 rs12190287 in the prediction and discrimination of CAD risk, individually or into a genetic risk score (GRS) formed by a set of 13 genetic variants.
Methods
We performed a case-control study with 3050 subjects (1619 coronary patients with 53.3±8 years; 78.9% male and 1431 controls with 52.8±8 years; 76.6% male) from GENEMACOR study. We investigated all traditional risk factors (TRF), as well as 13 genetic variants from GWAS with unknown pathophysiological pathway so far, including TCF21 (rs12190287), ZC3HC1 (rs11556924), PSRC1/SORTI (rs599839), PHACTR1 (rs1332844), MIA3 (rs17465637), SMAD3 (rs17228212), ZNF259 (rs964184), ADAMTS7 (rs3825807), CDKN2B (rs4977574), 9p21.3 (rs1333049), KIF6 (rs20455), PCSK9 (rs2114580) and GJA4 (rs618675). A multiplicative genetic risk score with these 13 genetic variants (m13GRS), was calculated. Subsequently, two logistic regressions were performed; primarily with all the TRF and all the genes individually and the second with TRF and m13GRS.
Results
The first multivariate analysis shows that, besides the strong association of the TRF with CAD risk (with smoking status on the top of the list, with an OR of 3.2; p<0.0001), TCF21 rs12190287 was the most significant variant from all the studied genetic set with a CAD risk of 1.5 (95% CI: 1.1–1.9; p=0.004), followed by the well-known genetic determinant CDKN2B rs4977574 (OR=1.4; 95% CI: 1.1–1.7; p<0.002) and ZC3HC1 rs11556924 (OR=1.3; 95% CI: 1.0–1.7; p=0.034). When GRS is included to the model, all the TRF remain in the equation by the same order, and the m13GRS persisted as an independent predictor for CAD risk (OR=1.7; 95% CI: 1.4–2.0; p<0.0001).
Conclusion
TCF21 rs12190287 is a risk factor for CAD in the Portuguese population, either individually or incorporated in a m13GRS. TCF21 risk is independent from TRF. In the future, TCF21 can provide a new clues to identify patients at high cardiovascular risk and become a potential target for gene therapy.
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Affiliation(s)
- J Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A Pereira
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - J Monteiro
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Neto
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A Drumond
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - R Palma Dos Reis
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
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Borges S, Palma Dos Reis R, Pereira A, Mendonca F, Sousa J, Monteiro J, Neto M, Sousa AC, Rodrigues M, Henriques E, Ornelas I, Freitas AI, Drumond A, Mendonca MI. P6200Effect of LPA gene on CAD risk among diabetic patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Previous research reported that LPA gene is a strong and independent predictor of CAD in non-diabetic patients but not in patients with type 2 diabetes. These results suggest that LPA gene might contribute less to CAD risk in patients with T2DM than in general population.
Objective
Investigate, in our population, the association between LPA gene CT variant and CAD risk among diabetic patients.
Methods
3050 individuals (1619 coronary patients and 1431 controls) were genotyped for LPA rs3798220 TT/CT. Pearson's chi-squared test was applied to evaluate the association between LPA variants and CAD, firstly, in the general population and, secondly, in the group of patients with T2DM (n=735). Multivariate logistic regression was performed with LPA CT variant and 6 traditional risk factors (TRF) (smoking, dyslipidemia, diabetes, hypertension, family history of CAD and physical inactivity) in both general and diabetic population.
Results
In total population, LPA CT variant was found to be strongly and significantly associated with CAD with an OR of 2.32 (95% CI: 1.56–3.45; p<0.0001). However, this association was less pronounced in the diabetic population with a CAD risk of 1.38 (95% CI: 0.56–3.43) without statistical significance (p=0.485). In the presence of 6 major TRF, multivariate analysis showed that LPA CT remained a strong and independent predictor of CAD risk (OR= 2.34; 95% CI: 1.52–3.62; p<0.0001). In diabetic population, LPA was no longer an independent predictor for CAD by multivariate analysis.
Conclusions
Our results show that the effect of LPA gene on CAD risk among diabetic patients might be different from that in the general population. Diabetes status is such a strong risk factor that may attenuate the genetic effects of LPA on CAD risk. This may indicate a complex role of Lp (a) and diabetes interaction in cardiometabolic diseases.
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Affiliation(s)
- S Borges
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences, Lisbon, Portugal
| | - A Pereira
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - J Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - J Monteiro
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Neto
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A I Freitas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | | | - M I Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
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Aguiar Ricardo I, Nunes-Ferreira A, Rigueira J, Agostinho J, Santos R, Lima Da Silva G, Silverio-Antonio P, Rodrigues T, Cunha N, Goncalves S, Santos L, Bernardes A, Pinto FJ, Marques P, Sousa J. P3808iBox-CRT: Better response, less complicated, equally fast. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The optimization of the left ventricle (LV) pacing site guided by the electrical delay increases CRT response rate (RR), however it's necessary to develop technology that allows its universal use.
Purpose
The aim is automatically, and operator-independent, access the conduction delay between the right ventricular (RV) stimulus and the LV available veins in order to select the LV pacing site. It is further intended to compare the total procedure and radiation times in relation to an historical control group.
Methods
Prospective, single-center study that included patients undergoing CRT implant according to the current ESC Guidelines. All patients were submitted to a clinical, electrocardiographic and echocardiographic basal evaluation prior to CRT implantation and at 6 months of follow-up.
To evaluate conduction delays between the RV lead and the LV available veins (RV-LV delay), an external interface - intelligent Box for CRT (iBox-CRT) was used. Four measurements in at least two different tributary veins were made. The implant of all the LV leads was guided by the longest measured delay.
A positive response to CRT was defined as an improvement of >10% in left ventricle ejection fraction (LVEF) or a reduction of end-systolic volume (ESV)>15%. The results were compared to a control group (CG) of pts submitted to CRT implantation in the conventional way.
Results
60 patients were included (68.3% males, 38% ischemic, mean age 67.4±10.2 years) and submitted to CRT implant (37 CRT-P; 23 CRT-D). At basal evaluation, LVEF was 28±7%, end-diastolic volume (EDV) was 200±73ml and ESV 145±64ml. CG (n=51) had similar characteristics.
The RR was 85.7%, significantly higher compared to the CG (55.9%, p=0.003). The ESV reduced 38.2±3% in responders vs 5.7±2% in non-responders (NR) (p=0,005), EDV reduced 33.3±16% in responders vs 13.6±10% in NR (p=0.002), the mean LVEF improved 11% in responders vs −1% in NR (p=0.02).
At follow-up, the mean ESV in the study group (SG) was 89±44 ml vs 132±75ml in the CG (p=0.002) and the EDV 136±51 vs 190±78 (p=0.007).
In addition to a much better response rate, the responders in the study group had significantly higher mean LVEF at follow-up (39±11% vs 37±7%, p=0.032).
The mean intra-procedure RV-LV delay was 187±34mseg. In the responder group the baseline delay was usually higher (190±35 msec) vs NR group RV-LV delay (165±23 msec; p=NS).
Compared with CG, the automatic assessment of RV-LV delay with iBox-CRT did not increase fluoroscopy time (15±16min vs 18±16; p=NS) and shortened procedure time (65±34 vs 108±83min, p<0.005).
Conclusions
The iBox-CRT use enabled an automatic and operator independent RV-LV delays measurement, in order to implant the LV lead at the most delayed site. This technique translated into a major increase in CTR response rate, not compromising the procedure duration nor increasing the radiation exposure.
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Affiliation(s)
- I Aguiar Ricardo
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - A Nunes-Ferreira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - J Rigueira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - J Agostinho
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - R Santos
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - G Lima Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - P Silverio-Antonio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - S Goncalves
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - L Santos
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - A Bernardes
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - F J Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - P Marques
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
| | - J Sousa
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology, Lisbon, Portugal
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Graca Rodrigues TE, Cortez-Dias N, Silva GL, Agostinho JR, Aguiar-Ricardo I, Rigueira J, Nunes-Ferreira A, Santos R, Cunha N, Morais P, Pereira S, Silverio-Antonio P, Carpinteiro L, Pinto FJ, Sousa J. P5689First intention epicardial VT ablation: what are the results? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Ventricular tachycardia (VT) endocardial mapping and ablation may not be sufficient in several arrhythmogenic contexts, because ventricular myocardium may comprise intricate endocardial, intramural and epicardial substract. Thus, epicardial ablation has lately become a complementary and necessary tool to approach some VTs in different types of cardiomyopathies.
Purposes
To evaluate the clinical characteristics of patient most suitable for first intention epicardial VT ablation and to describe our centre experience.
Methods
Single-centre prospective study of consecutive patients (pts) undergoing isolated first intention epicardial VT mapping and ablation since August 2015. All pts had clinical assessment, electrocardiogram (ECG), echocardiogram and cardiac magnetic resonance when feasible. Pts with a previous endocardial ablation were excluded. Epicardial subxiphoid access utilizing a tuhoy needle was performed under fluoroscopic guidance. High-density mapping was performed using CARTO® V4 and EnSite PrecisionTM systems and multipolar catheters. Radiofrequency energy was applied with an irrigated-tip catheter.
Results
First intention epicardial VT ablation was attempted in 12 pts (mean age 57.6±14.6 years, 91% male). The majority had non-ischemic dilated cardiomyopathy, of unknown aetiology in 59%, hereditary dilated cardiomyopathy in 17% ethanolic origin in 8% and post-myocarditis in 8%. Right Ventricular Arrhythmogenic Cardiomyopathy was present in 1 patient. As expected, our population presented a mean ejection fraction of 29% and 11 pts (92%) had an implantable cardioverter defibrillator - ICD (55% as primary prevention, 45% as secondary prevention). All pts had experienced symptomatic VT, with all ICD carriers receiving appropriate shocks. Only 4 pts had an available 12 lead ECG of the VT, and all of them had a QS pattern in lead aVL and a slurred initial QRS complex. The majority of patients presented low voltage areas and local abnormal ventricular activities at the epicardial surface, with the exception of 2 pts in whom ablation was not performed (one non-ischemic cardiomyopathy of ethanolic aetiology and the other of unknown origin). Mean ablation application time was 68 minutes, with an average maximum power of 39.9 watts. Mean overall procedure and fluoroscopic time was 132 and 24 minutes, respectively, with no major intraprocedural complications. During a mean follow-up of 307±328 days, 3 pts died (mean 121 days after procedure), 3 had recurrent VT episodes and ICD shocks, and 2 received heart transplant.
Conclusion
In selected pts, with non-ischemic dilated cardiomyopathy and ECG with QS pattern in aVL and slurred QRS, epicardial VT mapping and ablation may be used as first approach, preventing unnecessary endocardial mapping. This procedure demonstrated to be safe.
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Affiliation(s)
- T E Graca Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cortez-Dias
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - G L Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J R Agostinho
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Rigueira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Nunes-Ferreira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Santos
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Morais
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Pereira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silverio-Antonio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - L Carpinteiro
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - F J Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Sousa
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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Santos MR, Pereira A, Mendonca F, Sousa J, Neto M, Monteiro J, Sousa AC, Freitas S, Henriques E, Ornelas I, Drumond A, Palma Dos Reis R, Mendonca M. P6196Lipoprotein (a) and cardiovascular risk: are women at increased risk? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Coronary artery disease (CAD) is the leading cause of death worldwide, placing a major economic and resource burden on health and public health systems, so efforts are being made to accurately predict risk for major adverse cardiac events (MACE). The field of risk prediction and CAD prevention continues to evolve with the identification of novel risk factors and biomarkers, such as lipoprotein a [Lp)a]. Almost 20% of the population has elevated circulating levels of Lp(a), which is recognized as an independent risk factor for CAD, stroke, peripheral arterial disease, and aortic stenosis. Importantly, studies showed that this was particularly true for women.
Objective
To evaluate if the elevation of Lp(a) is associated with MACE in female, male or both.
Materials and methods
Case control study of 3050 subjects from the GENEMACOR study population. In female population (n=676): cases were 341 patients with at least one >75% coronary stenosis (median age 55.7±7.2) and 335 normal controls (median age 55.8±6) adjusted by age with cases. In male population (n=2374): 1278 patients with at least one >75% coronary stenosis (median age 52.7±8) and 1096 controls (median age 51.9±8) also adjusted by age. χ2 and T student tests were used to analyze the demographic, laboratorial, angiographic and anthropometric characteristics of the population. Lipoprotein (a) was determined by immunoturbidimetry. High Lp(a) level was considered if superior to 30 mg/dl. Logistic regression was used to evaluate Lp(a) as a risk factor for CAD in total, female and male populations.
Results
In female population 44.0% patients vs 21.2% controls (p<0.000) had Lp(a)>30mg/dl. In male population 39.4% patients vs 23.8% controls (p<0.000) had Lp(a)>30mg/dl. In total population Lp(a)>30mg/dl was a predictor for CAD (OR 2.24, 95% CI: 1.91–2.62, p<0.0001). Analyzing by gender, Lp(a)>30mg/dl was also a predictor for CAD either in male (OR 2.08, 95% CI: 1.74–2.5, p<0.0001) or female population (OR 2.92, 95% CI: 2.08–4.09, p<0.0001).
Conclusions
As opposed to other studies, in our population elevated Lp(a) levels (>30mg/dl) were associated with elevated CAD risk, in both men and women. We conclude that Lp(a) can be considered an independent risk factor for CAD disease in our population, and further strategies for Lp(a) reduction may indeed translate in improved outcomes in CAD disease.
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Affiliation(s)
- M R Santos
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A Pereira
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - J Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Neto
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - J Monteiro
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | | | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences, Lisbon, Portugal
| | - M Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
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45
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Pereira A, Mendonca M, Monteiro J, Sousa J, Mendonca F, Neto M, Rodrigues R, Sousa AC, Freitas S, Rodrigues M, Freitas AI, Borges S, Ornelas I, Drumond A, Palma Dos Reis R. P2486The association between genetic variant ZNF259 and decreased kidney function in the diabetic patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Type 2 Diabetes (T2D) is a risk factor for dysregulation of glomerular filtration rate (GFR) and albuminuria. However, it remains unclear whether this association is only causal. Genetic variants are inherited independent of potential confounding factors and represent a lifetime exposure.
Aim
Investigate whether the reduction of GFR is a direct consequence of T2D or there are other genetic mechanisms involved in the pathophysiology of the evolution to chronic kidney disease.
Methods
Cross-sectional study with a total of 2579 individuals was performed, of which 735 patients had T2D. Subjects were classified as `'diabetic” if they were taking oral anti-diabetic medication or insulin or if their fasting plasma glucose was higher than 7.0 mmol/l or 126 mg/dl. Within the diabetic group, we considered those with (n=63) and without (n=627) decreased GFR. GFR was calculated through the Cockcroft and Gault formula and decreased GFR was defined as GFR<60 ml/min/1.73m2. Twenty-four genetic variants associated with T2D, metabolic syndrome, dyslipidemia and hypertension were investigated for its impact on GFR, namely: MTHFR 677 and 1298; MTHFD1L; PON 55, 192 and 108; ATIR A/C; AGT M235T; ACE I/D; TCF7L2; SLC30A8; MC4R; ADIPOQ; FTO; TAS2R50; HNF4A; IGF2BP2; PPARG; PCSK9; KIF6; ZNF259; LPA; APOE; PSRS1. Risk factors for decreased GFR were also evaluated (essential hypertension, glycaemia >120 mg/ml, dyslipidemia, alcohol consumption, CAD diagnosis). A logistic regression was performed firstly with the risk factors solely; and secondly adding the genetic variants in order to evaluate the independent predictors of progression to renal failure in T2D.
Results
After the first multivariate logistic regression with all the risk factors for decreased GFR, only CAD remained in the equation, showing to be an independent risk factor for progression to renal failure, in T2D (OR=4.17; 95% CI: 1.64–10.59; p=0.003). In the second logistic regression, including risk factors and the genetic variants, only ZNF259 rs964184 showed an independent and significant association with the risk of decreased GFR (OR=3.03; 95% CI: 1.06–8.70; p=0.039).
Conclusion
This study shows that the variant ZNF259 rs964184 is associated with decreased kidney function, independently of other risk factors. This finding needs further investigation to clarify the genetic mechanism behind the association of rs964184 with decreased GFR, in Type 2 diabetes.
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Affiliation(s)
- A Pereira
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - J Monteiro
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - J Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Neto
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - R Rodrigues
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A I Freitas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | | | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences, Lisbon, Portugal
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46
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Sousa J, Mendonca M, Pereira A, Mendonca F, Neto M, Monteiro J, Sousa AC, Rodrigues M, Henriques E, Guerra G, Borges S, Ornelas I, Drumond A, Palma Dos Reis R. P3423The contribution of genetics to premature CAD through different degrees of lifestyle factors: a matter of relative significance? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Coronary artery disease (CAD) is a multifactorial process with substantial genetic contribution. However, genetic predisposition among patients with a different number of lifestyle factors and premature CAD, remains a complex and thoroughly unexplored topic.
Objective
To evaluate, in a young population, the importance of conventional risk factors as well as of a genetic risk score in the appearance of CAD.
Methods
A case-control study was conducted with 1075 patients from the GENEMACOR study population, under 50 years-old (555 cases, 86.8% male, mean age 44.1±4.9 years and 520 controls, 86.2% male, mean age 44.3±4.8 years). Univariate analysis addressed the association of different modifiable risk factors with premature CAD. Genetic risk score (GRS) was computed comprising 33 genetic risk variants in a multiplicative method. GRS was evaluated according to the number of traditional risk factors and risk for premature CAD was estimated and its independent predictive value estimated by logistic regression.
Results
72.6% of patients had ≥3 risk factors vs 31.2% of controls (p<0.0001). In comparison with having no risk factors (rf), patients with 1 rf had an OR of 2.79 (1.19–6.53; p=0.015), patients with 2 risk factors had a OR of 6.87 (3.03–15–57, p<0.0001) and patients with 3 modifiable risk factors had a OR of 24.17 (10.87–53.73, p<0.0001) – graph 1. In this young population, mean GRS level was consistently higher among patients with coronary artery disease comparing with a healthy population (0.6±0.6 vs 0.4±0.4, p<0.0001, respectively) – graph 2. GRS in multivariate analysis, proved to be an independent predictor for premature CAD (OR 1.71, CI95% 1.25–2.34, p=0.001).
Conclusion
In our population, GRS was an independent predictor for premature CAD. In young patients with ≥3 risk factors, genetics play a less decisive role in the development of CAD. Even in young patients, modifiable risk factors should be addressed aggressively as they may represent a higher burden than genetic predisposition itself.
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Affiliation(s)
- J Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A Pereira
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Neto
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - J Monteiro
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | | | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences, Lisbon, Portugal
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Sousa J, Mendonca M, Pereira A, Mendonca F, Neto M, Monteiro J, Sousa AC, Freitas S, Henriques E, Freitas AI, Borges S, Ornelas I, Drumond A, Palma Dos Reis R. P4455The controversial role of genetics behind premature CAD: a plausible excuse for the young? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
The complex interaction between genes and environmental factors contribute to individual-level risk of coronary artery disease (CAD), often resulting in premature CAD. The role for genetic risk scores in premature CAD is still controversial.
Objective
To evaluate the importance of conventional risk factors and of a genetic risk score in younger and older patients with coronary artery disease
Methods
From a group of 1619 pts with angiographic documented CAD from the GENEMACOR study, we selected 1276 pts admitted for ACS and analysed them in 2 groups (group A: ≤50 years, n=491 pts, 87.2% male, mean age 44±4.9 and group B: >50 years, n=785 pts, 75.2% male, mean age 57±4.2). Univariate analysis was used to characterize the traits of each group and we used ROC curves and respective AUCs to evaluate the power of genetics in the prediction of CAD, through a Genetic Risk Score (GRS).
Results
99.3% of the young patients had at least one modifiable risk factor, 18.4% had 2 modifiable risk factors and 75.2% had 3 or more modifiable risk factors. The pattern of risk factors contributing to CAD were different among groups: family history (A: 27.5%, B: 21.4%, p=0.015) and smoking habits (A: 64.8%, B: 42.9%, p<0.001) were more frequent among patients under 50, and traditional age-linked factors like hypertension (A: 58%, B: 75.7%, p<0.001), diabetes (A: 21.6%, B: 38.6%, p<0.001) were more common in the older group. Acute ST-elevation myocardial infarction was more frequent among the young (A: 55.4%, B: 47.4%, p=0.006), as non-ST clinical presentation was higher among elder patients. Regarding angiographic presentation, single vessel CAD was higher in group A (A: 50.3%, B: 40.9%, p<0.001), while multivessel diasease was higher in group B (A: 33.3%, B: 53.9%, p<0.001). At a mean follow-up of 5 years, older patients had a worst prognosis, registering a higher rate of cardiovascular death (A: 4.1%, B: 8.6%, p=0.002) and higher MACE (A: 26.8%, B: 31%, p=0.128),. Adding the genetic risk score (GRS), we achieved only a slight improvement in the AUC for predicting CAD (0.796->0.805, p=0.0178 and 0.748->0.761, p=0.0007 in patients under and over 50, respectively).
Conclusion
Coronary artery disease is not all the same, as premature CAD shares a unique and specific pattern of risk factors, clinical presentation, angiographic severity and prognosis. Genetics should not be used as an excuse to justify premature CAD, as there is frequently more than one potentially reversible risk factor present even in young patients and the additive predictive value of GRS is modest.
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Affiliation(s)
- J Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A Pereira
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Neto
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - J Monteiro
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A I Freitas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | | | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences, Lisbon, Portugal
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48
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Santos B, Cruz N, Carvalho P, Fernandes A, Sousa J, Gonçalves B, Riva M, Pollastrone F, Centioli C, Marocco D, Esposito B, Correia C, Cardoso J, Pereira R. Linux device driver for Radial Neutron Camera in view of ITER long pulses with variable data throughput. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2019.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Geilfus NX, Munson KM, Sousa J, Germanov Y, Bhugaloo S, Babb D, Wang F. Distribution and impacts of microplastic incorporation within sea ice. Mar Pollut Bull 2019; 145:463-473. [PMID: 31590811 DOI: 10.1016/j.marpolbul.2019.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 05/27/2023]
Abstract
Microplastics (plastic particles <5 mm) are an emerging concern in Arctic sea ice with measured concentrations orders of magnitude higher than in surface seawater. However, incorporation of microplastics into sea ice, and their impact on sea ice properties, is unknown. We added microplastic particles in a microcosm experiment to determine microplastic distributions and effects on sea ice properties. Microplastic additions did not affect sea ice growth, but high concentrations of microplastics at the ice surface resulted in high ice salinity and changes in sea ice albedo. Field studies in the Gulf of Bothnia (Baltic Sea) showed sea ice concentration of microplastics from 8 to 41 particles per liter of melted ice, wich were much lower than those found to impact sea ice properties in the microcosm experiments. However, should microplastic concentrations increase, microplastic incorporation in sea ice may impact sea ice albedo.
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Affiliation(s)
- N-X Geilfus
- Centre for Earth Observation Science and Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
| | - K M Munson
- Centre for Earth Observation Science and Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - J Sousa
- International Union for Conservation of Nature, Global Marine and Polar Programme, 1196 Gland, Switzerland
| | - Y Germanov
- Centre for Earth Observation Science and Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - S Bhugaloo
- Centre for Earth Observation Science and Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - D Babb
- Centre for Earth Observation Science and Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - F Wang
- Centre for Earth Observation Science and Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
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50
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Faria MT, Oliveira A, Vilas-Boas MC, Maia PM, Rego R, Sousa J, Pereira J, Cunha JPS, Rocha-Goncalves F, Martins E. P278Validation of HMPAO-Tc-99m as a myocardial perfusion radiotracer: preliminary results. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez148.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M T Faria
- Centro Hospitalar Universitário de São João, E.P.E., Nuclear Medicine Department, Porto, Portugal
| | - A Oliveira
- Centro Hospitalar Universitário de São João, E.P.E., Nuclear Medicine Department, Porto, Portugal
| | - M C Vilas-Boas
- Institute for Systems Engineering and Computers - Technology and Science (INESC TEC), FEUP, Porto, Portugal
| | - P M Maia
- Institute for Systems Engineering and Computers - Technology and Science (INESC TEC), FEUP, Porto, Portugal
| | - R Rego
- Centro Hospitalar Universitário de São João, E.P.E., Neurophysiology Unit, Neurology Department, Porto, Portugal
| | - J Sousa
- Centro Hospitalar Universitário de São João, E.P.E., Angiology and Vascular Surgery Department, Porto, Portugal
| | - J Pereira
- Centro Hospitalar Universitário de São João, E.P.E., Nuclear Medicine Department, Porto, Portugal
| | - J P S Cunha
- Institute for Systems Engineering and Computers - Technology and Science (INESC TEC), FEUP, Porto, Portugal
| | - F Rocha-Goncalves
- Faculty of Medicine University of Porto, Medicine Department, Porto, Portugal
| | - E Martins
- Faculty of Medicine University of Porto, Medicine Department, Porto, Portugal
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